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Diabetes supplier dropped from lawsuit

HME News - Thu, 11/30/2017 - 14:29
11/30/2017HME News Staff

INDIANAPOLIS – J&B Medical Supply has been dismissed from a lawsuit alleging it had sold blood glucose test strips under the retail pharmacy benefit rather than the DME benefit.

All charges were dismissed without prejudice and without costs, according to a court filing.

The lawsuit, filed earlier this year by Roche Diagnostics and Roche Diabetes Care, claimed that they wrongfully paid millions of dollars in rebates in lost millions of dollars in legitimate sales to an alleged scheme by several pharmacies and medical supply companies.

J&B Medical at the time said it stopped purchasing test strips from Roche in 2009.

In addition to the Wixom, Mich.-based J&B Medical, the suit named several other Michigan companies: Binson’s Hospital Supplies and Northwood, both of Centerline; Olympus Global in East Lansing; and Delta Global in Flint; as well as Alpha XE in Cheyenne, Wyoming.

HHS details status of appeals backlog

HME News - Wed, 11/29/2017 - 14:33
11/29/2017HME News Staff

FALLS CHURCH, Va. – The Office of Medicare Hearings and Appeals receives more than a year’s worth of appeals work every 24 weeks at the third level of appeals, according to a recent PDF posted to the agency’s website.

As of the end of the fourth quarter of fiscal year 2016, the pending workload at the administrative law judge level exceeded 650,000 appeals, while annual adjudication capacity going forward was about 92,000 appeals, according to the “HHS Primer: The Medicare Appeals Process.”

At the first and second level of appeals, CMS is currently meeting its statutory timeframes to process appeals and is not experiencing a backlog, HHS says.

At the fourth level of appeals, the Medicare Appeals Council is currently receiving more than a year’s worth of appeals work every 10 weeks. As of the end of the fourth quarter of fiscal year 2016, the pending workload at the council exceeded 22,000 appeals, while annual adjudication capacity was about 2,600 appeals, HHS says.

Several companies are generating a significant portion of the appeals backlog, HHS says. Four DME companies and one state Medicaid agency filed 51% of appeals at the ALJ level in the first quarter of fiscal year 2015, it says. Three DME companies filed 35% of the appeals at the second level of appeals, or the QIC level, in 2015 compared to just 12% in 2012.

HHS says the current appeals structure encourages appellants to appeal every claim because there is no filing fee and because the minimum amount in controversy required for an ALJ hearing, $160, is substantially lower than the amount required for judicial review, $1,560.

HHS says it has a three-pronged approach to addressing the backlog and improving the system: invest new resources at all levels of appeal to increase adjudication capacity and implement new strategies to alleviate the current backlog; take administrative actions to reduce the number of pending appeals and encourage resolution of cases earlier in the process; and propose legislative reforms that provide additional funding and new authorities to address the appeals volume.

Without administrative action, HHS estimates the appeals backlog at OMHA will exceed 1.5 million by the end of fiscal year 2021.

CMS starts implementation process for Cures provision

HME News - Tue, 11/28/2017 - 12:47
11/28/2017HME News Staff

WASHINGTON – CMS wants state Medicaid programs to submit their DME fee schedules using a new spreadsheet to make sure they’re not paying too much for equipment, according to a notice in the Federal Register.

CMS says the spreadsheet will help the agency comply with a provision in the 21st Century Cures Act that requires it to cap Medicaid reimbursement for DME at Medicare reimbursement starting Jan. 1, 2018.

“We would require the minimal amount of information be collected from states to comply with this statute (at 8 hours per state per year),” the agency states in the notice. “More specifically, we would ask states to demonstrate compliance by filling in their DME fee schedules onto the new spreadsheet page with the relevant information—HCPCS code series A, K, and E only, that are relevant to this information collection of durable medical equipment.”

CMS is accepting comments on the new program through Jan. 29, 2018.

Industry stakeholders have been waiting for details on how CMS plans to comply with the provision in the Cures Act. The provision was included in the act as a “pay-for.”

Attitudes towards Aging often Affect Health

Long Term Care Link - Sun, 11/26/2017 - 20:00
Among the myriad of wonderful ideas available to caregivers for coping with the care of a loved one, some strategies that can influence the attitude of care recipients are often neglected.

Attitudes towards Aging often Affect Health

Long Term Care Link - Sun, 11/26/2017 - 20:00
This article uses the term aging seniors and final years of life frequently.

How Does Guardianship Help an Aging Senior?

Long Term Care Link - Sun, 11/26/2017 - 20:00
A guardian is an agency or person legally appointed to manage the affairs of an individual who lacks the capacity to make responsible decisions concerning his or her personal matters.

Plan for Long Term Care Before You Need It

Long Term Care Link - Sun, 11/26/2017 - 20:00
Long Term Care Planning is the process of preparing for and funding long term care.

Seniors and Retirees, Consider Using a Reverse Mortgage to Supplement Income

Long Term Care Link - Sun, 11/26/2017 - 20:00
For many seniors and retirees, the hard-earned equity in their home is their single largest asset, yet it is unavailable to use unless they take out a home-equity loan.

The Value of Geriatric Care Management Services

Long Term Care Link - Sun, 11/26/2017 - 20:00
Also known as Care Management or Aging Care Management, a Geriatric Care Manager represents a growing service offering support to adult children who need outside assistance with care and personal management for their aging parents who live close by or far away.

How the Funeral Rule Helps Consumers

Long Term Care Link - Sun, 11/26/2017 - 20:00
In 1984 the Federal Trade Commission established the Funeral Rule to give consumers of funeral services certain protections.

Caring for a Loved One at Home Can Be Challenging

Long Term Care Link - Sun, 11/26/2017 - 20:00
Informal caregivers are family, friends and volunteers who provide care and support for an aging loved one. These selfless individuals are rarely paid for their services and often endure a significant amount of stress while providing care.

Estate Planning As Part of Your Long Term Care Plan

Long Term Care Link - Sun, 11/26/2017 - 20:00
A key deficiency in the process of planning for long term care occurs when seniors fail to provide for the orderly distribution of assets after death or fail to let their family know what to do when the senior can no longer handle his or her own affairs.

Perpetrators of Elder Abuse Are Usually Family Members

Long Term Care Link - Sun, 11/26/2017 - 20:00
Many elderly rely entirely on family or other trusted individuals to help them. Whether it is physiological or psychological, as people grow older they tend to need guidance and support. Unfortunately, the dependence upon caregivers or family members makes an older person more vulnerable to abuse.

Osteoporosis - What You Need To Know

Long Term Care Link - Sun, 11/26/2017 - 20:00
Your body is constantly replacing bone, the older you are, the slower the bone is replaced. Osteoporosis is a bone disease that happens when the body loses too much bone or makes too little bone.

Include End-Of-Life Planning When Anticipating Long Term Care

Long Term Care Link - Sun, 11/26/2017 - 20:00
A key deficiency in the process of planning for long term care occurs when seniors fail to provide for orderly distribution of assets at death and fail to let their family know what to do when the senior can no longer handle his or her own affairs.

Gut Health and Antibiotics

Long Term Care Link - Sun, 11/26/2017 - 20:00
Most people do not think about gut health. In fact, the majority of people don't know what gut health is.

What Should I Expect to Pay for Funeral and Burial Expenses

Long Term Care Link - Sun, 11/26/2017 - 20:00
A common goal among many aging seniors and their families is to put money aside for funeral and burial expenses.

Arthritis Among Seniors

Long Term Care Link - Sun, 11/26/2017 - 20:00
Arthritis affects millions of people of all ages, including children (1 in every 250 children in the United States each year).

Parkinsons Disease

Long Term Care Link - Sun, 11/26/2017 - 20:00
In the U.S., over one million Americans suffer from Parkinsons disease (approximately 10 million worldwide).

What to Do When an Aging Loved One Dies

Long Term Care Link - Sun, 11/26/2017 - 20:00
If and when my parent passes away,which will likely take place in my own home, I wouldnt know what to do.
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