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Sebelius resigns from HHS

HME News - Fri, 04/11/2014 - 10:08
04/11/2014HME News Staff

WASHINGTON – Kathleen Sebelius has resigned after serving five years as secretary of the Department of Health and Human Services.

President Barack Obama is expected to nominate Sylvia Mathews Burwell, director of the Office of Management and Budget (OMB), to replace Sebelius, news organizations report. 

The Senate will have to confirm Burwell, who was approved by a 96-0 vote to take the helm at OMB last year. 

Should she be confirmed, Burwell will lead preparation for the next open-enrollment period for the nation’s health insurance exchanges and the delayed employer mandate, news reports say.

During her tenure at HHS, Sebelius made Medicare fraud prevention a priority. In 2009, Sebelius and Attorney General Eric Holder formed the Health Care Fraud Prevention and Enforcement Action Team (HEAT); and expanded the scope of Strike Force operations.

Sebelius’s tenure was marked by heavy criticism of her department’s messy rollout of the Affordable Care Act’s insurance marketplace exchanges.

QMES repositions with $50M in financing

HME News - Thu, 04/10/2014 - 09:31
04/10/2014HME News Staff

NEW YORK – QMES, a distributor of DME in nine states, has secured a $50 million senior secured credit facility from CIT Corporate Finance, Healthcare.

QMES will use the facility to refinance legacy debt and provide for ongoing working capital needs, according to a press release.

“QMES has an impressive track record of growth having completed 10 acquisitions since 2012 and effectively establishing itself as one of the largest medical equipment home delivery companies on the East Coast," stated William Douglass, managing director and group head of CIT Corporate Finance, Healthcare, a provider of financing and advisory services to small businesses and middle-market companies. “We look forward to building this relationship.”

QMES is a portfolio company of Quadrant Management, a New York-based private equity and restructuring firm. LMI is also a portfolio company of the firm.

QMES distributes medical supplies to patients in Pennsylvania, New Jersey, Connecticut, Delaware, New Hampshire, New York, Massachusetts, Maryland and Rhode Island. It was created in 2012 through various acquisitions.

“CIT clearly understood our sector and was the ideal partner to support us as we looked to evolve our financial structure to reflect to the company we’ve become and position ourselves for the future,” said Luke McGee, chairman and CEO of QMES.

Terms of the deal were not disclosed.

GAO analyzes bid program’s impact

HME News - Wed, 04/09/2014 - 11:13
04/09/2014HME News Staff

WASHINGTON – The number of both beneficiaries and DME suppliers declined in Round 1 competitive bidding program areas in 2012, according to a new report issued yesterday by the Government Accountability Office (GAO).

To conduct its study, the GAO compared Medicare claims data from 2011 and 2012 with 2010 for beneficiaries; and compared claims data for 2012 with 2010 for contract and non-contract suppliers. For monitoring purposes, CMS had selected nine “comparator” areas that were demographically similar to the nine Round 1 competitive bidding areas.

Findings

• The GAO found that the number of beneficiaries in the CBAs decreased more in the bid areas compared to the comparator areas. For example, the number of beneficiaries receiving oxygen supplies decreased by about 22% in bid areas vs. 16% in the comparator areas. CMS attributes the decrease to a reduction in inappropriate use.

However, the GAO did state that the termination of The Scooter Store's contract in 2013 could create access issues for beneficiaries seeking repairs in those CBAs.

• The GAO also found that, in general, a small number of contract suppliers had a large portion of market share in the nine CBAs and that the top four contract suppliers generally accounted for a larger proportion of the market, although the top four contract suppliers were not the same in every CBA.

• The total number of DME suppliers and Medicare allowed charges decreased more in the nine bid areas. For example, the number of suppliers with allowed charges of $2,500 or more decreased, on average, 27% in CBAs vs. 5% in the comparator areas.

In conclusion the GAO stated the competitive bidding program does not appear to have impacted beneficiary access to covered items. However, states the report, CMS must continue monitoring the effects of the expansion of the program to 100 areas in July 2013 and of the national mail-order program for diabetes supplies. 

According to CMS, the program saved estimated $400 million in its first two years.

OIG weighs in on CMS oversight of bid program

HME News - Tue, 04/08/2014 - 11:31
04/08/2014HME News Staff

WASHINGTON – As part of the Round 1 of competitive bidding, CMS generally selected DMEPOS suppliers and correctly computed the sampled single payment amounts in accordance with its established procedures and applicable federal requirements, according to a report published today by the Office of Inspector General (OIG).

Specifically, the OIG determined that for 255 of the 266 contract suppliers associated with the sampled single payment amounts reviewed, CMS consistently followed its procedures and applicable federal requirements.

To conduct its investigation, the OIG randomly sampled 100 of the 3,011 established single payment amounts in the Round 1 re-bid program and examined the selection process for the 266 contract suppliers in the sample. It reviewed 63,906 lines of service related to the sample, totaling about $5.1 million paid during the first six months of 2011.

While the overall effect was immaterial, the OIG determined that for 11 of the 266 contract suppliers, CMS did not consistently follow its established procedures and applicable federal requirements, affecting 19 of the 100 sampled single payment amounts. Specifically, CMS awarded contracts to nine suppliers that did not meet financial documentation requirements, and it incorrectly used two suppliers in one single payment computation.

On the basis of its sample, the OIG estimates that CMS paid suppliers $33,704 less than they would have received without any errors, or less than 0.1% of the $113 million paid under the program in the first six months of 2011.

The OIG recommends that CMS follow its established program procedures and applicable federal requirements consistently in evaluating the financial documents of all suppliers; and ensure that all bids are included in the calculation of single payment amounts before offering contracts.

CMS concurred with the OIG’s recommendations.

Bid expansion: Rural providers look ahead with trepidation

HME News - Fri, 04/04/2014 - 13:06
04/04/2014Theresa Flaherty

YARMOUTH, Maine – In its service area in Montana, Harrington Surgical Supply is often the only game in town.

“We have a salesperson once a week in some towns,” said Dan Harrington, owner of Harrington Surgical Supply in Butte, Mont. “If we didn’t come, then nobody would.”

That’s likely to get worse if CMS applies competitive bidding payment amounts nationwide, something it is required to do by 2016 under the Affordable Care Act. In February, CMS published an advance notice of proposed rulemaking seeking comment on developing a methodology to adjust payment rates in non-bid areas.

Although providers in rural areas might be spared from having to bid, an average reimbursement cut of 45% would be tough for them to absorb.

“That’s less than what we pay (to buy the products),” said Harrington. “You couldn’t sell to Medicare beneficiaries—that’s the bottom line.”

Ninety-seven percent of the respondents to a recent survey by The VGM group said costs vary based on the size of the market in terms of population and geography. Probably the single biggest cost for rural providers: deliveries.

“Our geographic area is huge,” said Shawn Murchison, operations manager for Fort Fairfield, Maine-based Acadia Medical. “Sometimes we are driving forever. We spend a lot on vehicle costs, the cost of travel, and the cost of time.”

Other factors drive up costs, as well. For example, getting freight shipped to the far reaches of northern Maine doesn’t come cheap, says Murchison.

“On the smaller stuff, it’s not a big deal,” he said. “For something big like a stairlift or a power wheelchair, it’s probably tacking on another $100 to get it here on our loading dock.”

If local providers stop accepting Medicare, CMS can’t count on having national providers fill the gap. Many providers in rural areas report a very limited presence—if at all—by the Aprias and Lincares of the industry.

“People in rural areas like to support the hometown folks,” said Mike Marnhout, owner/president of Lexington, Ky.-based Bluegrass Medical, which serves several rural areas.

In years past, lawmakers have introduced legislation seeking to exempt rural providers from competitive bidding—to no avail.

“Given that the rural providers weren’t exempted and were not able to bid based on their market, there’s been a renewed push for some sort of reform,” said Peter Rankin, government affairs manager for AAHomecare. “We’re hoping that CMS will listen to us on some things.”

Capped-rental rule takes effect

HME News - Fri, 04/04/2014 - 13:05
And it’s already affecting business decisions for complex rehab providers04/04/2014Leah Hoenen

WASHINGTON – Although providers hoped to hear “April Fools,” the rule transitioning certain complex rehab items to capped-rental status went into effect Tuesday as planned.

“This change in regulation is so ridiculous, and the basis behind it is so ridiculous, that my Pollyanna personality made me believe we were really going to get a delay or have the whole thing retracted,” said Doug Westerdahl, president of Monroe Wheelchair.

Stakeholders and lawmakers called on CMS to delay implementation of the rule re-classifying 78 codes, including tilt-in-space manual wheelchairs, pediatric manual wheelchairs and manual wheelchairs with power assist, as capped-rental items.

Industry leaders will now work with the lawmakers behind their bill to create a separate benefit for complex rehab to add an amendment making all complex rehab items available as a purchase or with a purchase option.

“The complexity this adds to what I’d call a very, very delicate situation is uncalled for,” said Bruce Bayes, president and CEO of Custom Mobility. “There’s no way a provider can provide, on a rental basis, what is needed on a permanent basis.”

With the rule in effect, numerous real-life implications are starting to take shape. Should a patient be hospitalized, for example, the provider must now stop billing during the hospitalization, then resume rental when the patient is released. That means storing the items, then bringing them back out for use, Bayes said.

“We’re going to take care of our customers, but we will not be able to, in the long term, provide brand-new equipment totally customized to that individual on and off again,” Bayes said. “You physically cannot do it.”

While they wait for scenarios like these to crop up, providers are already making business decisions like limiting the choices they offer customers. Monroe Wheelchair will still provide manual tilt-in-space chairs, but only from a limited number of manufacturers, said Westerdahl.

Additionally, Monroe Wheelchair will no longer provide power-assist devices. On April 1, it cancelled three orders, said Westerdahl.

“They’re too expensive and require too much service,” he said.

Adding insult to injury: The overall billing process for these items will now end up costing more.

“The 5% additional revenues we will realize over the 13 months will not cover the additional costs we are going to incur,” said Westerdahl.

 

Private payers put squeeze on sleep

HME News - Fri, 04/04/2014 - 13:03
‘They are trying to decrease sleep studies’04/04/2014Theresa Flaherty

YARMOUTH, Maine – Since the first of the year, CPAP providers have seen an onslaught of policy changes among private insurers that have made it harder for them to do business.

“Every day, we hear of a new insurance company putting more restraints on getting services,” said Lisa Feierstein, president and co-founder of Raleigh, N.C.-based Active Healthcare. “It’s almost like the insurance companies want to limit access to care.”

One of the biggest changes: an increase in the use of prior authorizations for CPAP/supplies and sleep studies, whether it’s a full study in a sleep lab or a home sleep test, say providers.

“We happen to own two sleep labs and we’ve absolutely seen an increase in PAs,” said Ron Evans, owner of Phoenix-based Valley Respiratory Services. “Sixty percent are now requiring PAs and it used to be less than 10%.”

While prior authorizations are nothing new for full sleep studies, they’re new for home sleep testing. Traditionally, private insurers have seen the benefits of the technology—it’s patient preferred and less costly—and green-lighted these tests.

That’s been provider Erik Parkhill’s experience.

“I think probably 60% of the payers cover home sleep tests at 100%,” said Parkhill, vice president of HMP Diagnostics in Gainesville, Ga.

But as utilization for home sleep tests continues to rise, more private insurers will attempt to slow that growth, too, predicts Feierstein.

“The insurers are trying to decrease sleep studies,” she sad. “They are putting in lots of controls.”

Name of the game is integration, Mediware says

HME News - Fri, 04/04/2014 - 13:02
04/04/2014Liz Beaulieu

LENEXA, Kan. – Mediware Information Systems expects to have one business management platform for multiple post-acute care providers, including HME, commercially available in January 2015.

“We have solid products, but they’re in silos, and we’re seeing the lines between those silos blur,” said Thomas Mann, president and CEO. “More and more providers are expanding their growth into vertical adjacent markets and they need to have their infrastructure on one platform.”

Mediware expects to put the new platform, in development for more than two years, through quality assurance testing this summer and beta testing this fall.

The new platform will marry a host of legacy systems, as well as new systems that Mediware has recently acquired, such as Definitive Homecare Solutions and Fastrack. Definitive’s CPR+ platform will serve as the foundation of the new platform, Mann says.

“We’ve done a very exhaustive gap analysis of all our products to determine their strengths so we can capitalize on those strengths,” he said. “One is strong in point of sale; one in billing; one, CPR+, had the largest customer base. This will give us a solid release.”

As part of the new platform, Mediware will offer individual modules to providers who don’t do business across multiple markets, says Paul O’Toole, vice president and general manager of Home Care Solutions.

“It will be the same user interface, with one patient index and one patient billing system, but they’ll be able to turn on and off certain functions,” he said.

Mediware will also continue to support its legacy systems “through the next couple of months and years,” Mann says, in light of the transition from ICD-9 to ICD-10.

“We’d love to get them on the new platform as soon as they’re comfortable,” said Jonathan Seiter, vice president of marketing. “But it’s only as soon as they’re comfortable. We don’t want to force anyone.”

Mann added: “And we’re trying to build a product that they’ll want to move to.”

While the new platform will incorporate HME, home infusion, specialty pharmacy and home health, Mediware hasn’t ruled out adding other markets, such as skilled-nursing, long-term care and rehab, down the road, Mann says.

“We’ll consolidate those along with the market,” he said. “With everything moving toward an integrated delivery network, we should be able to capitalize on that.”

In brief: ICD-10 delay is final, patent case nears trial

HME News - Fri, 04/04/2014 - 13:00
04/04/2014HME News Staff

WASHINGTON – President Obama has signed a “doc fix” bill that delays ICD-10 implementation for at least one year, until Oct. 1, 2015. The Senate passed the bill last week, and the House of Representatives passed the bill on March 27. The “doc fix” bill prevents a 24% cut in physician pay for another year, until April 1, 2015. It’s the 16th time that Congress has passed such a patch on physician pay, rather than come up with a permanent fix, according to reports. Reaction to the ICD-10 delay was mixed. While it gives breathing room to some organizations, it frustrates others that have committed resources to transitioning to the new set of codes by the original deadline, Oct. 1, 2014, according to reports. Like the House bill, the Senate bill did not address competitive bidding. “Although we’re disappointed that Congress didn’t include fixes for Medicare’s poorly managed bidding program, we’ll continue to get cosponsors for H.R. 1717 and look for another piece of legislation that can carry its provisions,” said Tom Ryan, president and CEO of AAHomecare, in a statement. H.R. 1717, which would replace the competitive bidding program with a market-pricing program (MPP), currently has 171 co-sponsors.

Patent case nears trial

SAN DIEGO – Just ahead of a trial, ResMed has dropped one of its patent infringement claims against BMC Medical/3B Medical, according to BMC/3B Medical. ResMed voluntarily withdrew the patent from investigation after an International Trade Commission (ITC) administrative law judge issued a ruling that restricted the scope of its claims, according to a release. ResMed in May 2013 filed a lawsuit against BMC and announced several months later that the ITC had agreed to investigate theChinese medical device manufacturer and its U.S.-based distributors, 3B Medical and 3B Products, for patent infringement.A trial is scheduled for April 10. ResMed filed a similar lawsuit against Taiwanese manufacturer Apex Medical in 2013. The U.S. patent and trademark office in February agreed to re-examine five ResMed patents in response to challenges filed by Apex.

Letter sends ‘strong message’ about bid program

WASHINGTON – A letter urging CMS Administrator Marilyn Tavenner not to expand competitive bidding until the Office of Inspector General (OIG) has completed its investigation into the program has been signed by 83 members of Congress, according to The VGM Group. Reps. Glenn Thompson, R-Pa., and Bruce Braley, D-Iowa, who spearheaded the effort, stated in the letter: “Concerns have stemmed from the lack of transparency, the improper vetting of the financial wherewithal of many firms that have been awarded contracts, and design flaws that were identified by over 240 economists and auction experts.” VGM says the letter, which was sent to Tavenner on March 28, sends a “strong message.”

Bid program would save Medi-Cal millions, OIG says

WASHINGTON – Medi-Cal, California’s Medicaid program, could have saved $3.9 million on standard power wheelchairs, oxygen systems and oxygen concentrators in 2011 by using a competitive bidding program, the Office of Inspector General (OIG) has found. In its report, the OIG recommended Medi-Cal establish a bidding program like Medicare’s, or revise its reimbursement methodology so pricing is more in line with bid prices. Though it disagreed with the OIG’s estimated savings, Medi-Cal agrees it should change its reimbursement methodology in 2014, according to the report. “The state agency indicated that it would be more cost-effective to align DME rates to 80% of Medicare’s rates annually and that it will update its DME Medi-Cal rates in 2014,” the report stated.  Medi-Cal also said it would review a competitive bidding program to determine the costs and benefits associated with implementing such a program in the future, according to the report. The OIG reviewed $12 million in Medi-Cal payments for standard power wheelchairs, oxygen systems and oxygen concentrators. Auditors compared payments made by Medi-Cal to those made in certain cities in California as part of Round 1 of competitive bidding.

FAA drafts sleep apnea guidelines

FREDERICK, Md. – The Federal Aviation Administration (FAA) has drafted new guidelines for diagnosing sleep apnea among pilots, according to news reports. Under the new guidelines, announced April 1, pilots will not be disqualified from flying based on body mass index alone. The change came about after opposition from pilots, lawmakers and physicians forced the FAA to put on hold its plans to start testing pilots for sleep apnea in January. The House of Representatives passed a bill in February that would require the FAA to go through a rulemaking process before implementing a sleep policy. The agency had said that was unnecessary because untreated sleep apnea already disqualifies a pilot from flying. Under the draft guidelines, aviation medical examiners (AMEs) will continue to ask questions related to sleep apnea, as they have done since 2009. If a pilot is referred for evaluation for sleep apnea, the examiner will issue a regular medical certificate and the pilot will have 90 days to get an assessment. The pilot can keep flying during that 90-day period and the assessment can be conducted by any physician, not just a sleep specialist, and a sleep test is not required if the doctor feels it is unnecessary.

Separate benefit bill lands more co-sponsors

WASHINGTON – A bill in the House of Representatives to create a separate benefit for complex rehab now has 107 sponsors—67 Democrats and 40 Republicans. Co-sponsors include 17 members of the House Ways and Means Committee and 10 members of the Energy and Commerce Committee, NCART reported in a recent bulletin. “We need to continue to build support and awareness so our bill is in a position to be attached to the next piece of Medicare legislation,” wrote Don Clayback, NCART executive director. A similar bill in the Senate now has 12 co-sponsors, including members of the Finance Committee and the Health, Education, Labor and Pension Committee. Sen. Chuck Schumer, D-N.Y., tried unsuccessfully to have the bill attached to the “doc fix” bill recently passed by Congress.

Region C RAC announces new reviews

WILTON, Conn. – Suction catheters for tracheostomy and speech generating devices and accessories will be subject to prepayment reviews by Connolly, the Region C RAC. For suction catheters, the company will conduct an automated review to evaluate overpayments identified when claims billed for suction catheters were not done in accordance with the billing requirements outlined in local coverage determinations (LCDs). The review of speech generating devices and accessories is a complex review evaluating medical documentation to determine whether items met coverage indications and limitations and/or medical necessity as outlined in the LCD.

Toyota, VMI launch second Star Spangled Salute contest

PHOENIX – Vantage Mobility International (VMI) and Toyota on April 2 announced the launch of the Second Annual Operation Independence Star Spangled Salute contest. Through the online contest, disabled military veterans can win a new Toyota Sienna outfitted with VMI’s Access 360 In-floor Ramp Conversion system. The contest is open through Nov. 9. The name of the randomly selected winner will be announced on Veterans Day.

Incontinence provider has it in the bag

YARMOUTH, Maine – Home Delivered is now offering Tranquility brand incontinence products by the bag. Buying by the bag allows users to determine what product will work best for them without having to buy a whole case, according to a press release. Although it’s more costly to order by the bag, the company believes the convenience outweighs the cost. The mail-order provider offers a full range of adult incontinence products.

Technology to drive growth in HME market

DALLAS – U.S. demand for home medical equipment is forecast to grow 8.2% annually to $12.6 billion in 2018, according to a report by RnRMarketResearch. Underlying growth: advances in technology for portable oxygen concentrators, remote telemedicine systems and home dialysis machines. “Cost saving advantages will promote the increasing substitution of home health care for hospital, ambulatory and nursing home procedures whenever feasible,” the report states. Among HME, remote monitoring and real-time systems based on telemedicine technology will generate the fastest revenue growth, as physicians, hospitals and other medical providers are pressured by health insurers to become accountable for improving patient outcomes and controlling costs, according to the report.

Numotion strengthens presence in Milwaukee

ROCKY HILL, Conn., and ST. LOUIS – Numotion has acquired the mobility division of AccessAbility Home Medical and Rehab, a Milwaukee-based provider of mobility, respiratory and DME. “The sale of our mobility business will allow us to focus on the DME and respiratory product line, in addition to our affiliated company, Access Elevator,” stated Owner Jon Tevz in a press release. As part of the deal, Numotion will pick up the company’s three assistive technology professionals (ATPs) and other experienced support staff. “(This) will allow Numotion to strengthen its relationships with key referral sources throughout the Milwaukee area,” stated Tim Havel, regional vice president, in the release. Numotion has been acquiring a steady stream of mobility companies since it was formed by the merger of ATG Rehab and United Seating and Mobility in January 2013.

Short takes: Brightree, Inogen, Roscoe Medical

Atlanta-basedBrightree has launched Brightree Home Infusion, a new solution to address the clinical, operational and billing needs of home infusion pharmacies. The solution allows pharmacies to use a single, cloud-based platform for orders, inventory, labels, billing, drug utilization and medical tracking. Additionally, pharmacies that also provide HME medications and HME equipment and supplies can now simplify operations and reduce costs by using one sales order in a single, fully integrated system…Goleta, Calif.-based Inogen has been added to the Russell 2000 and Russell 3000 Indexes. The Russell 2000 Index measures the performance of the small-cap segment of the U.S. equity market. It’s a subset of the Russell 3000 and represents about 10% of the total market capitalization of that index…NXT Capital has provided a $78.1 million senior secured facility to fund Roscoe Medical’s acquisition of Carex Health Brands. NXT Capital was the joint lead arranger, sole bookrunner and administrative agent for the transaction.

People in the news: Jan Erickson, Sen. Isakson, Colleen Brabec, Svein Ryan

Jan Erickson, president of Colorado Springs, Colo.-based Janska, has been named Colorado Small Business Person of the Year by the U.S. Small Business Administration. Janska, founded in 2003, is a maker of women’s clothing that enhances dignity. It can be found in more than 900 specialty gift and clothing boutiques, and 10 catalogs in the U.S. and Canada…Sen. Johnny Isakson, R-Ga., gave the keynote address at the National Home Infusion Association’s 2014 Annual Conference and Exposition, March 31-April 3. Isakson told attendees he had a profound appreciation for their work because it allowed his son to recover at home rather than in a hospital in 1989. “As one constituent who had your services save a son’s life, I know how important what you do is,” he said…Colleen Brabec, owner and general manager of Council Bluffs, Iowa-based Mobilis, is the winner of the 2014 MAMES Above and Beyond Award. Winners of the award are recognized for their work going “above and beyond” on a state, regional and/or national level. MAMES commended Brabec for, among other things, hosting a roundtable meeting to educate lawmakers on the negative impact of competitive bidding…Svein Ryan has been appointed to the position of vice president, marketing and development, for SCA’s Personal Care business in North America. Ryan has worked for SCA for 25 years in its personal care business, managing sales teams in Norway, Sweden, Romania, Greece, Austria and Germany.

CMS targets 12 new states for PMD demo

HME News - Fri, 04/04/2014 - 10:22
04/04/2014HME News Staff

WASHINGTON – The PMD demo is about to get bigger.

In an April 4 emergency federal register notice, CMS details plans to expand its prior authorization program to 12 new states: Pennsylvania, Ohio, Louisiana, Missouri, Maryland, New Jersey, Indiana, Kentucky, Georgia, Tennessee, Washington and Arizona. 

That will bring the total number of demo states to 19.

“We believe that this demonstration prevents public harm by protecting the Medicare Trust Fund from improper payments made for PMDs that do not comply with Medicare policy and by ensuring that a beneficiary’s medical condition warrants the medical equipment ordered,” the agency stated.

The demo, which requires providers or physicians to submit prior authorization requests to DME MACs for evaluation before an item is delivered or service rendered, has been in place in seven states—California, Texas, Illinois, Michigan, New York, North Carolina and Florida—since September 2012.

As a result of the demo, spending on power mobility devices fell from $11 million in September 2012 to $5 million in June 2013.

In the notice, CMS asks the Office of Management and Budget to review and approve its request by April 18. 

HME News recently reported that, at the behest of the Senate Finance Committee, the industry has drafted language that would expand the demo to all 50 states and would expand it to include all power mobility devices, including Group 3 wheelchairs.

Bid program would save Medi-Cal millions, OIG says

HME News - Thu, 04/03/2014 - 11:34
04/03/2014HME News Staff

WASHINGTON – Medi-Cal, California’s Medicaid program, could have saved $3.9 million on standard power wheelchairs, oxygen systems and oxygen concentrators in 2011 by using a competitive bidding program, the Office of Inspector General (OIG) has found.

In its report, the OIG recommended Medi-Cal establish a bidding program like Medicare’s, or revise its reimbursement methodology so pricing is more in line with bid prices.

Though it disagreed with the OIG’s estimated savings, Medi-Cal agrees it should change its reimbursement methodology in 2014, according to the report. 

“The state agency indicated that it would be more cost-effective to align DME rates to 80% of Medicare’s rates annually and that it will update its DME Medi-Cal rates in 2014,” the report stated. 

Medi-Cal also said it would review a competitive bidding program to determine the costs and benefits associated with implementing such a program in the future, according to the report.

The OIG reviewed $12 million in Medi-Cal payments for standard power wheelchairs, oxygen systems and oxygen concentrators. Auditors compared payments made by Medi-Cal to those made in certain cities in California as part of Round 1 of competitive bidding.

Patent case nears trial

HME News - Wed, 04/02/2014 - 11:09
04/02/2014HME News Staff

SAN DIEGO – Just ahead of a trial, ResMed has dropped one of its patent infringement claims against BMC Medical/3B Medical, according to BMC/3B Medical.

ResMed voluntarily withdrew the patent from investigation after an International Trade Commission (ITC) administrative law judge issued a ruling that restricted the scope of its claims, according to a release.

ResMed in May 2013 filed a lawsuit against BMC and announced several months later that the ITC had agreed to investigate theChinese medical device manufacturer and its U.S.-based distributors, 3B Medical and 3B Products, for patent infringement.

A trial is scheduled for April 10.

ResMed filed a similar suit against Taiwanese manufacturer Apex Medical in 2013. The U.S. patent and trademark office in February agreed to re-examine five ResMed patents in response to challenges filed by Apex.

ICD-10 delay heads to president

HME News - Tue, 04/01/2014 - 10:05
04/01/2014HME News Staff

WASHINGTON – The Senate yesterday passed a “doc fix” bill that delays ICD-10 implementation for one year, until Oct. 1, 2015, according to news reports.

The House of Representatives passed a similar bill on March 27.

The “doc fix” bill, which now heads to the president’s desk, prevents a 24% cut in physician pay for another year, until April 1, 2015.

It’s the 16th time that Congress has passed such a patch on physician pay, rather than come up with a permanent fix, according to reports.

Reaction to the ICD-10 delay was mixed. While it gives breathing room to some organizations, it frustrates others that have committed resources to transitioning to the new set of codes by the original deadline, Oct. 1, 2014, according to reports.

Like the House bill, the Senate bill did not address competitive bidding.

“Although we’re disappointed that Congress didn’t include fixes for Medicare’s poorly managed bidding program, we’ll continue to get cosponsors for H.R. 1717 and look for another piece of legislation that can carry its provisions,” said Tom Ryan, president and CEO of AAHomecare, in a statement.

H.R. 1717, which would replace the competitive bidding program with a market-pricing program (MPP), currently has 171 co-sponsors.

Living Arrangements for Aging Seniors

Long Term Care Link - Sun, 03/30/2014 - 19:00
Senior housing options can be confusing to someone who has never approached the subject before. Often the definition of a particular senior housing term is dependent upon the person writing about the subject. The reason for the confusion is that most retirement care and senior housing arrangements provide overlapping services among the various categories.

Care Management Advice

Long Term Care Link - Sun, 03/30/2014 - 19:00
Care management advice should be something that every family takes advantage of but in reality very few families use this service.

Holiday Caregiver Burnout

Long Term Care Link - Sun, 03/30/2014 - 19:00
Whether you are at the end of your tether, that tether has been cut years ago or you are just starting Caregiving for a loved one this time of year always seems to be the hardest. The season of joy is upon us, that is what the media, shopping centers and carolers want you to believe, but for many, the season of joy is really just more WORK!

The Beginning of the End-Of-Life Planning

Long Term Care Link - Sun, 03/30/2014 - 19:00
There are so many moments when you think about what you want for your final years in life. It is never too late and never too early to prepare yourself and those around you for your final wishes.

Holiday Blues - Depression among the Elderly

Long Term Care Link - Sun, 03/30/2014 - 19:00
The holiday season offers many opportunities to spend quality time with family and friends. If you are a caregiver or family member of an aging loved one, you may observe a change in their mood or behavior during the holidays. You may notice unusual signs of fatigue or sadness or perhaps limited interest in the holiday season.

Medicare Open Enrollment Starts October 15

Long Term Care Link - Sun, 03/30/2014 - 19:00
It is that time of year again to consider making changes to your existing Medicare Plans. Medicares Open Enrollment period gives all beneficiaries the opportunity to make changes to their plans as their lives and needs change.

Home Repair Loan and Grant Program

Long Term Care Link - Sun, 03/30/2014 - 19:00
Rural Development makes loans for repairs to improve or modernize a home for families and individuals with very low incomes. These improvements are intended to make it safer or more sanitary, and/or even to remove health hazards. For seniors 62 and older who cannot afford a loan, grant funds many be available for these necessary repairs.
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