Feed aggregator

Trump, man of mystery

HME News - Fri, 11/11/2016 - 13:05
Stakeholders latch on to president-elect’s stances on small government11/11/2016Theresa Flaherty

WASHINGTON – Industry stakeholders are looking ahead at what a Trump presidency could mean for HME.

“If it was anyone other than Donald Trump, I would be able to tell you a lot more,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “He’s not a traditional Republican. It’s unclear what his congressional agenda is and what his proposals really mean.”

What is clear is that Trump, a businessman with no political experience, struck a chord with Americans who are fed up with politics as usual.

Trump certainly resonated with HME providers, who say they are burdened under the weight of Medicare’s competitive bidding program and an environment of general over-regulation. In September, 64% of respondents to an HME Newspoll said they’d vote for Trump.

“Trump’s mantra is that he wants to slash regulations, he wants to slash bureaucracy—that’s all great for DME,” said John Gallagher, vice president of government relations for The VGM Group. “One of the problems we’ve had is, because of the divided government, none of the committees of jurisdiction had control over CMS. CMS being put back in its bottle would be tremendous.”

With both the White House and both chambers of Congress soon to be under Republican control, stakeholders say they expect a more sympathetic ear to the industry’s plight—especially from lawmakers representing rural America, which came out in droves to support Trump.

“Rural America has been forgotten for a long time,” said Gallagher. “Trump’s speech said, we are going to bring jobs back, so we have to make sure we are talking to our members of Congress abut the same thing. We have got to have rural relief (from competitive bidding), and particularly the delay (of the second round of cuts on July 1), to save these businesses before they are gone.”

On a higher level, a big question on everyone’s mind: What about the Affordable Care Act? Trump has vowed to repeal the program, but whether he tries for a complete repeal or keeps certain provisions in place is uncertain.

“There’s a lot of speculation, but we are really focused on the next three or four weeks and getting (bid relief) passed,” said Jay Witter, senior vice president of public policy for AAHomecare. “It’s all about the leadership and the mindset: What can you get done? I think they are still sorting it out.”

In addition to the 20 million Americans who have obtained health insurance through the ACA, the act has also initiated many programs—like those reducing hospital readmissions—that put more emphasis on post-acute care, including the role of HME providers, say stakeholders.

“Everybody would agree that post-acute care is where people get more care at less cost,” said Bachenheimer. “There are so many ramifications in terms of dismantling some of these huge things that Health and Human Services has moved forward.”

Stakeholders who visited Capitol Hill in the days after Trump’s upset say the shock is palpable, but they feel good about the industry’s chances of getting bid relief passed in the lame-duck session, particularly since its champions, including Rep. Tom Price, R-Ga., won re-election.

“We feel strong and good,” said Tom Ryan, president and CEO of AAHomecare. “We need help now. We are losing infrastructure and businesses daily. That was the message a week ago and that hasn’t changed.”

 

Inogen puts POCs at forefront

HME News - Fri, 11/11/2016 - 13:03
Company acknowledges ‘growing pains’ in HME industry, but offers POCs as solution to providing adequate service and achieving financial return11/11/2016Liz Beaulieu

GOLETA, Calif. – Inogen’s hybrid approach to the HME industry continues to pay off, with the company yet again posting double-digit increases in revenues and net income for the third quarter of 2016.

Inogen, which provides its portable oxygen concentrators both through HME providers and direct-to-consumer, reported total revenues of $54.4 million for the third quarter of 2016 compared to $40.8 million for the same period last year, a 33.5% increase. Net income was $3.5 million vs. $2.7 million, a 28.2% increase.

“One of the reasons that I think we are a compelling solution for the HME community (is) we know a little bit about taking care of patients, probably more so than the average manufacturer that hasn’t gone down the path of a direct-to-consumer play,” said Scott Wilkinson, president and COO.

Fairly recently, Inogen also began providing its POCs through a private label partner.

While Inogen’s business-to-business and direct-to-consumer sales were up considerably in the third quarter—65.1% and 38.6%, respectively—rental sales were down 37.2%. Still, CEO Ray Huggenberger said the company will remain in the “reimbursement business as far as we can see.”
“The issue is that what we’re undergoing right now is growing pains,” he said. “The entire reimbursement world through competitive bidding has changed significantly and the pendulum has probably swung a little bit from the left side all the way to the other side. That doesn’t mean that it won’t come back. We can’t say, ‘Let’s punt on the rental business because it provides us with a couple of difficult challenging quarters.’”

In fact, it’s those “growing pains” that are part of what’s driving Inogen’s sales and overall POC adoption, as HME providers seek to provide oxygen therapy more cost effectively. Wilkinson cited recent CMS data that showed an 8% adoption rate for 2015, up from 6.9% for 2014.

“We believe this data may represent a conservative estimate of actual portable oxygen concentrator market penetration,” he said.

In its role as a provider battling competitive bidding itself, Inogen is doing OK. In the Round 2 re-compete that went live July 1, the company has contracts for respiratory in 93 of the 117 competitive bidding areas, with reimbursement of, on average, $114.74 per month compared to $135.79 per month in the previous round. In Round 1 2017, which goes live Jan. 1, it has contracts for respiratory in 10 of the 13 CBAs, with reimbursement of, on average, $114.03 per month vs. $133.82 per month.

Wilkinson credits Inogen’s non-delivery model for allowing the company to make the contracts work.

“It’s pretty clear that the HME community is struggling with the new reimbursement cuts and the rates,” he said. “They’re looking for new solutions and how they can provide adequate service and still achieve an attractive financial return at these new rates, and POCs are at the forefront of that solution set.”

Invacare ramps up context

HME News - Fri, 11/11/2016 - 13:01
Of three-phase transformation, CEO says, ‘This is going to be more of a walk through a forest to a destination than a walk in a straight line’11/11/2016Liz Beaulieu

ELYRIA, Ohio – Matthew Monaghan wants investors to look past the net losses and sales decreases that dominate Invacare’s latest financial results.

During an Oct. 31 conference call to discuss Invacare’s results for the third quarter, Monaghan, chairman, president and CEO, outlined a three-phase transformation that he believes will, ultimately, land the company with more than $1.1 billion in net sales on a constant currency basis and with gross profit of more than 30%.

“I want to put today’s quarterly release in the context of the plan we’re executing to our investors and prospective investors, so you can more easily understand the long-term value being created,” he said.

Invacare reported a net loss of $5 million for the third quarter of 2016 compared to $7.8 million for the same period last year. It reported net sales of $268.1 million vs. $283.8 million. The company reported a net loss of $25.2 million for the nine months ended Sept. 30, compared to $23.3 million for same period last year. It reported net sales of $800.7 million vs. $859.1 million.

Monaghan says Invacare is currently in the first phase of the transformation, which entails strengthening the balance sheet, developing and expanding talent, accelerating quality efforts, strengthening the North America commercial team, shifting product mix and restarting the innovation pipeline.

Invacare has made progress in this first phase of the transformation, Monaghan says, as evidenced by the successful sale of its Garden City Medical business, as well as its launch of two new products, the LiNX control system in Europe, a wirelessly programmable complex power wheelchair control system; and the Alber Twion power assist device for active manual wheelchair users.

Monaghan says this first phase of the transformation has been “especially intensive” on the North America HME business, which saw net sales of $98 million for the third quarter, a 14.5% decrease, and net sales of $314 million for the first nine months of the year, a 12.5% decrease.

To relieve some pressure, Monaghan says Invacare made the tough decision in October to “right-size” certain parts of the North America HME business in line with shifts in staffing needs, a move that is expected to save about $2.6 million annually.

Until Invacare completes the third phase of its transformation sometime in 2019, Monaghan acknowledges that “not every quarter is going to be smoothly interpolated between where we started and where we’re going.”
“In terms of metrics, by analogy, this is going to be more of a walk through a forest to a destination than a walk in a straight line,” he said.

BioScrip ‘took its eye off the ball’

HME News - Fri, 11/11/2016 - 13:00
11/11/2016Theresa Flaherty

DENVER – With revenues at BioScrip sliding again in the third quarter, new President and CEO Daniel Greenleaf didn’t mince words on a recent earnings call.

“Clearly, the organization took its eye off the ball in the third,” he said. “The people that were involved are no longer part of the organization in any way, shape or form.”

Greenleaf took the reins in September when BioScrip completed its acquisition of HS Holdings, where he had served as CEO since 2014. Prior to that, he served in leadership roles at Coram and Apria.

Net revenues for the third quarter of 2016 were $224.5 million, a decrease of 9.2% from a year ago. Net losses from continuing operations were $11.1 million vs. $24.5 million. Gross profit was 62.6 million or 29% of revenues; and EBITDA was a “disappointing” $3.5 million vs. $6 million, said Jeffrey Kreger, senior vice president, CFO and treasurer.

“This (EBITDA) was the result of lower than expected core revenue combined with higher than expected year-over-year operational expenses, principally in labor,” he said on the call.

BioScrip has, over the last several quarters, sought to shift its focus away from chronic infusion therapies toward its core infusion therapies. Currently split 35% and 65%, respectively, Greenleaf would like to push the core business to 85%.

“Core therapies are profitable therapies,” he said.

Higher than expected operating expenses are attributed to the integration of HS Solutions, which BioScrip paid $75 million for in September. On the call, Greenleaf reassured investors that he has taken on “challenging business situations” before, at both Home Solutions and Coram.

“I think many people, after Apria bought Coram, thought it was a bad idea,” he said. “When I joined, it had $500 million in revenue and $5 million in EBITDA.”

In late 2013, Apria sold Coram to CVS Caremark for $2.1 billion.

The next 18 to 24 months will be a time of great transformation, said Greenleaf. In addition to synergies between BioScrip and Home Solutions that are expected to achieve $14 million to $17 million in savings, Greenleaf has identified areas of substantial cost savings in areas like labor, nursing, supply chain management and deliveries.

For example, BioScrip will use UPS and FedEx “more aggressively,” he said.

“A delivery driver costs $55 compared to $15 for FedEx,” he said. “We want to get to between 65% and 75% of deliveries through FedEx and UPS.”

NCART seeks info from ‘front lines’

HME News - Fri, 11/11/2016 - 12:59
11/11/2016Tracy Orzel

WASHINGTON – NCART is conducting a “National CRT Medicaid Survey” to gather information on complex rehab bases, accessories and repairs at the state level.

The purpose: identify states with access issues and use that data to support efforts to pass separate benefit recognition legislation in individual states. 

“There might be some basic DME policies on the Medicaid website, but they don’t drill down to the level of complex rehab items,” said Don Clayback, executive director of NCART. “So that’s really our focus: people who are on the front lines and can give us up-to-date and accurate information.”

The last time NCART conducted a national survey was in 2010.

The survey, launched in November and available at www.surveymonkey.com/r/surveycrt, asks complex rehab providers questions about payment rates, claims submissions and prior approval processing.The survey also includes open-ended questions, such as: What are the top issues in your state that are limiting complex rehab access?

Those who wish to participate in the survey have until Dec. 2. They will receive a copy of the results.

While the results won’t impact legislation at the federal level, they will facilitate ongoing work on a state level.

“CRT legislation at the state level is a whole different animal,” said Clayback. “Because each state program is different, it’s not governed by the Social Security Act like the Medicare benefit is, so we don’t look at it as creating a separate benefit category, we look at it as creating separate benefit recognition. And that recognition will provide a sound policy around coverage, payment rates and supplier standards.”

To date, Washington, Colorado, Connecticut, Oklahoma and, most recently, Illinois, have successfully passed separate benefit recognition legislation. Efforts are under way to do the same in New York, where a bill has been introduced, and in Florida, Michigan, Ohio and Wisconsin.

https://www.surveymonkey.com/r/SurveyCRT

In brief: OIG to review bid program, HHS asks court not to intervene in Medicare appeals process

HME News - Fri, 11/11/2016 - 12:57
11/11/2016HME News Staff

WASHINGTON – The Office of Inspector General has released its work plan for 2017, including post-award audits to assess CMS’s competitive bidding program.

The OIG will review the process CMS used to conduct competitive bidding and to make subsequent pricing determinations for certain medical equipment items and services in selected bid areas under Rounds 1 and 2 of the program. It will also determine the effects of the competitive bidding on Medicare beneficiaries' access to certain types of DMEPOS subject to the program.

Other DME-related items in the OIG’s work plan for 2017:

Diabetes

The OIG is required to report the market share of diabetic testing strips before each subsequent round of the competitive bidding program to help CMS determine how the National Mail Order Re-compete may impact shifts in the market.

The first of three data briefs will determine the market share of diabetic testing strips for the three-month period immediately preceding the implementation of the National Mail Order Re-compete on July 1, 2016 (April through June 2016).

The second report will be for the three-month period immediately after implementation (July through September 2016) and the third report will be for a similar time frame six months after implementation (October through December 2016).

CPAP devices

Prior OIG work found that suppliers automatically shipped PAP device supplies when no physician orders for refills were in effect. The OIG will review claims for frequently replaced PAP device supplies to determine whether documentation requirements for medical necessity, frequency of replacement, and other Medicare requirements are met.

PMDs

The OIG will determine whether potential savings can be achieved by Medicare if certain PMDs are rented over a 13-month period (the period of consecutive months of rental at which the Medicare payment is capped) rather than acquired through a lump-sum purchase.

Orthotic braces

We will determine the reasonableness of Medicare fee schedule amounts for orthotic braces. We will compare Medicare payments made for orthotic braces to amounts paid by non-Medicare payers, such as private insurance companies, to identify potentially wasteful spending. We will estimate the financial impact on Medicare and on beneficiaries of aligning the fee schedule for orthotic braces with those of non-Medicare payers.

HHS asks court to back off

WASHINGTON – The Department of Health and Human Services has asked the U.S. District Court for the District of Columbia not to intervene in the Medicare appeals process.

In a brief filed Nov. 7, HHS asks for the dismissal of a case brought by the American Hospital Association that seeks a court order requiring HHS to implement procedures that would curtail a massive appeals backlog.

HHS recently reopened a settlement program that offers certain hospitals an opportunity to receive nearly two-thirds of their contested reimbursement in exchange for dropping their appeals. The agency told the court in its brief that this program, when combined with a number of other administrative and legislative actions, could reduce the appeals backlog to zero by 2019.

Previously, on Sept. 19, the court denied HHS’s request to put litigation with AHA on hold until Sept. 30, 2017, telling the agency it must solve the backlog at the Administrative Law Judge level.

CMS announces 2017 premiums

WASHINGTON – For about 70% of Medicare beneficiaries, the average monthly premium for Part B services will be about $109 in 2017, compared to $104.90 for the past four years, CMS announced Nov. 10.

Premiums for this group are protected from sharp increases by a statutory “hold harmless” provision designed to protect seniors, the agency says.

“This year, as in the past, the Secretary has exercised her statutory authority to mitigate projected premium increases for these beneficiaries, while continuing to maintain a prudent level of reserves to protect against unexpected costs,” CMS stated in a press release. “The Department of Health and Human Services (HHS) will work with Congress as it explores budget-neutral solutions to challenges created by the ‘hold harmless’ provision.”

For the remaining 30% of beneficiaries, the average monthly premium for Part B services will be $134 in 2017, a 10% increase from the premium in 2016, CMS says.

Beneficiaries not subject to the “hold harmless” provision include those who do not receive Social Security benefits, those who enroll in Part B for the first time in 2017, those who directly billed for their Part B premium, those who are dually eligible for Medicaid and have their premium paid by state Medicaid agencies, and those who pay an income-related premium, CMS says.

Philips, Masimo settle lawsuits

AMSTERDAM and IRVINE, Calif. – Royal Philips and Masimo have entered into a business partnership agreement that ends all pending lawsuits between the two companies.

As part of the agreement, Philips is released from having to pay a $467 million jury verdict that was awarded to Masimo in October 2014. Instead, it will pay $300 million to Masimo in the fourth quarter, and will make certain marketing and product integration commitments over the coming years.

“I am very satisfied that we have reached an agreement that is beneficial for both companies and that we have ended our legal disputes,” said Frans van Houten, CEO of Royal Philips in a press release. “Going forward, Philips and Masimo will completely focus on jointly delivering meaningful innovations to our customers.”

Philips and Masimo have agreed to jointly market and sell in North America and certain markets in Asia and Europe Masimo’s non-invasive sensor technologies, such as its rainbow and SET platforms, in conjunction with Philips’ patient monitoring and select therapy solutions.

Additionally, Philips will in the future integrate Masimo SedLine brain functioning monitoring, O3 regional oximetry and Nomoline capnography technologies in certain Philips IntelliVue monitors.

“This business partnership agreement marks an important day for us and our customers as two leaders in patient monitoring collaborate to develop solutions designed to enhance clinical outcomes and patient safety,” van Houten said.

Entering into the agreement has minimal impact on Philips’ income from operations in the fourth quarter of 2016, according to the release.

Masimo expects to use some of the after-tax proceeds from the agreement to repay amounts outstanding under its revolving line of credit, the release says.

Happy Veterans Day: Apria participates in ribbon campaign, Geriatric Medical joins forces with Operation Hat Trick

LAKE FOREST, Calif. - Apria Healthcare is encouraging its employees to participate in November’s “Yellow Ribbon Campaign” by placing a yellow ribbon, a symbol of remembrance and awareness, outside their cubicle, homes and facilities to show their support for service members. Apria has a long history of helping veterans transition back into the workforce through company-wide and nationwide initiatives. In 2016, the provider initiated a Facebook “friending” campaign and created Veteran Connect, an internal platform for Apria veterans and employees to network and share experiences with one another. It also joined the Department of Defense Military Spouse Employment Partnership (MSEP), an employment and career program that connects military spouses with employers and was awarded the Patriot Award from the Employer Support of the Guard and Reserve Committee (ESGR), for supporting veterans who have served in the National Guard or Reserve.

Geriatric Medical joins forces with veterans group

WOBURN, Mass. – Geriatric Medical & Surgical Supply has partnered with Operation Hat Trick to raise awareness of the importance of supporting wounded service members and veterans and helping them recover. Geriatric Medical and 47Brand have designed OHT hands to raise money for the organization, which pays for adaptive equipment for amputees, services docs, critical care, emergency rent and other help. “My grandfather originally conceived our company during the waning days of World War II on the decks of a naval destroyer being built at the Boston Naval Shipyard,” said Jeffrey Seigal, Geriatric Medical CEO. “As a third generation family business and an active member of the community, Geriatric Medical is proud to support America’s bravest through its relationship with OHT.”     

Nevada ends tax on DME

CARSON CITY, Nev. – Residents of Nevada has voted to exempt DME from the state sales tax. Question #4 passed overwhelmingly with 72% of the vote. “It’s a major win for the citizens of Nevada,” said Rich Pozesky, president of The Nevada State Association of Medical Product Suppliers, in a release. “This is only step one of the process; however, we are confident that this issue will eventually be law in our state.” Earlier this year, a coalition of HME providers gathered more than 100,000 signatures to put the issue on the November ballot. While the majority of voters voted in favor of the measure, it must pass two election cycles for it to go into effect.

Numotion makes inroads into Texas

FORT WORTH, Texas – Numotion has acquired Home Medical Equipment (HME) of Texas to extend its reach and capacity in the state. HME of Texas has been in business for more than 20 years, serving all of Texas from its location in Fort Worth. “Their knowledge of the Texas market, specifically the eastern and western parts of the state, will improve our coverage and enable us to positively impact many more lives by serving the mobility needs of our customers,” said Mike Swinford, CEO, in a press release. HME of Texas also brings extensive experience with the Applied Income Program of the Texas Department of Aging and Disability Services (DADS). Numotion will apply best practices from HME of Texas to streamline and improve how it interacts with DADS to ensure that choice and mobility needs for customers are optimized. Short term, HME of Texas’ 13 employees will continue to operate from its location in Forth Worth. Next year, that location, along with Numotion’s current branch in Fort Worth, will move into a new facility to align resources and better serve customers.

Quantum hits milestone with iLevel

EXETER, Pa. – Quantum Rehab says its iLevel power-adjustable seat height technology has now been embraced by more than 5,000 users. Launched in July 2015, iLevel elevates the seat of a wheelchair up to 10 inches and, thanks to Extra Stability Technology, allows for full functionality at walking height and speeds up to 3.5 mph. Quantum says the success of iLevel is due to both user demand and an ever-changing understanding by payers toward funding the technology. “Consumers are telling the industry that static wheelchair height in complex rehab is less and less acceptable in their lives,” said John Storie, director of sales for eastern America. “We are witnessing ‘standing height’ mobility become the new norm. As iLevel numbers demonstrate, consumers are shifting toward demanding the most functional, inclusive mobility technologies possible.”

FDA clears 3B Medical’s remote settings

WINTER HAVEN, Fla. – 3B Medical has received 510(k) clearance from the U.S. Food and Drug Administration for the remote device setting capabilities of iCodeConnect, the company announced Nov. 10. “With this software enhancement, therapy and prescription settings can now be adjusted and applied to Luna CPAP and Auto-CPAP devices remotely through 3B’s patient management portal,” the company stated in a press release. “This capability allows clinicians to make prescription changes and update all device settings through iCodeConnect easily and efficiently.” iCodeConnect allows clinicians to manage patient records, develop patient compliance reports, track overall treatment progress of patients, and more.

HealthLinc scores distribution deal for Keeogo

VANCOUVER – HealthLinc Medical Equipment, doing business as HME Mobility & Accessibility, will distribute the Keeogo powered walking assistance device in British Columbia. Keeogo was developed by B-TEMIA, a medical device manufacturer founded in 2010 that specializes in what it calls “human augmentation systems.” The Keeogo has been used by individuals with degenerative medical conditions, such as knee/hip osteoarthritis, multiple sclerosis, Parkinson’s disease, stroke, incomplete spinal cord injury and other conditions that limit mobility. The Keeogo is currently part of a multi-center pivotal clinical trial, part of the process of getting clearance from the U.S. Food and Drug Administration, to enter the U.S. market.

AAHomecare returns to Crystal City

ARLINGTON, Va. – AAHomecare is relocating its offices from Washington, D.C., to Arlington, Va., to save on rent andput membership dues to better use. The change will also allow the association to reach Capitol Hill faster, it says. “This move provides us the opportunity to budget more for lobbying, industry studies, education, member services, and innovative industry techniques that will help our members flourish in these difficult legislative and regulatory times,” AAHomecare stated in a release. The association will be moving to 241 18th Street South, Suite 500, Arlington, Va., 22202. The move will be completed by Nov. 16. AAHomecare's main phone number (202-372-0107) and individual staff phone numbers will remain unchanged.

People news: Walnut Medical Services

Johnstown, Pa.-based Walnut Medical Services has promoted Jodi Clark to director. Clark began her career at the company in 1991 and has held various positions there, most recently assistant director. In her new role, she will manage all operations. Walnut Medical Services is a provider of HME and supplies with four locations in west central Pennsylvania.

CMS announces 2017 premiums

HME News - Fri, 11/11/2016 - 11:28
11/11/2016HME News Staff

WASHINGTON – For about 70% of Medicare beneficiaries, the average monthly premium for Part B services will be about $109 in 2017, compared to $104.90 for the past four years, CMS announced Nov. 10.

Premiums for this group are protected from sharp increases by a statutory “hold harmless” provision designed to protect seniors, the agency says.

“This year, as in the past, the Secretary has exercised her statutory authority to mitigate projected premium increases for these beneficiaries, while continuing to maintain a prudent level of reserves to protect against unexpected costs,” CMS stated in a press release. “The Department of Health and Human Services (HHS) will work with Congress as it explores budget-neutral solutions to challenges created by the ‘hold harmless’ provision.”

For the remaining 30% of beneficiaries, the average monthly premium for Part B services will be $134 in 2017, a 10% increase from the premium in 2016, CMS says.

Beneficiaries not subject to the “hold harmless” provision include those who do not receive Social Security benefits, those who enroll in Part B for the first time in 2017, those who directly billed for their Part B premium, those who are dually eligible for Medicaid and have their premium paid by state Medicaid agencies, and those who pay an income-related premium, CMS says.

OIG to review competitive bidding program

HME News - Thu, 11/10/2016 - 16:05
11/10/2016HME News Staff

WASHINGTON – The Office of Inspector General has released its work plan for 2017, including post-award audits to assess CMS’s competitive bidding program.

The OIG will review the process CMS used to conduct competitive bidding and to make subsequent pricing determinations for certain medical equipment items and services in selected bid areas under Rounds 1 and 2 of the program. It will also determine the effects of the competitive bidding on Medicare beneficiaries' access to certain types of DMEPOS subject to the program.

Other DME-related items in the OIG’s work plan for 2017:

Diabetes

The OIG is required to report the market share of diabetic testing strips before each subsequent round of the competitive bidding program to help CMS determine how the National Mail Order Re-compete may impact shifts in the market.

The first of three data briefs will determine the market share of diabetic testing strips for the three-month period immediately preceding the implementation of the National Mail Order Re-compete on July 1, 2016 (April through June 2016).

The second report will be for the three-month period immediately after implementation (July through September 2016) and the third report will be for a similar time frame six months after implementation (October through December 2016).

CPAP devices

Prior OIG work found that suppliers automatically shipped PAP device supplies when no physician orders for refills were in effect. The OIG will review claims for frequently replaced PAP device supplies to determine whether documentation requirements for medical necessity, frequency of replacement, and other Medicare requirements are met.

PMDs

The OIG will determine whether potential savings can be achieved by Medicare if certain PMDs are rented over a 13-month period (the period of consecutive months of rental at which the Medicare payment is capped) rather than acquired through a lump-sum purchase.

Orthotic braces

We will determine the reasonableness of Medicare fee schedule amounts for orthotic braces. We will compare Medicare payments made for orthotic braces to amounts paid by non-Medicare payers, such as private insurance companies, to identify potentially wasteful spending. We will estimate the financial impact on Medicare and on beneficiaries of aligning the fee schedule for orthotic braces with those of non-Medicare payers.

HHS asks court to back off

HME News - Wed, 11/09/2016 - 15:40
11/09/2016HME News Staff

WASHINGTON – The Department of Health and Human Services has asked the U.S. District Court for the District of Columbia not to intervene in the Medicare appeals process.

In a brief filed Nov. 7, HHS asks for the dismissal of a case brought by the American Hospital Association that seeks a court order requiring HHS to implement procedures that would curtail a massive appeals backlog.

HHS recently reopened a settlement program that offers certain hospitals an opportunity to receive nearly two-thirds of their contested reimbursement in exchange for dropping their appeals. The agency told the court in its brief that this program, when combined with a number of other administrative and legislative actions, could reduce the appeals backlog to zero by 2019.

Previously, on Sept. 19, the court denied HHS’s request to put litigation with AHA on hold until Sept. 30, 2017, telling the agency it must solve the backlog at the Administrative Law Judge level.

Philips, Masimo settle lawsuits

HME News - Tue, 11/08/2016 - 09:44
11/08/2016HME News Staff

AMSTERDAM and IRVINE, Calif. – Royal Philips and Masimo have entered into a business partnership agreement that ends all pending lawsuits between the two companies.

As part of the agreement, Philips is released from having to pay a $467 million jury verdict that was awarded to Masimo in October 2014. Instead, it will pay $300 million to Masimo in the fourth quarter, and will make certain marketing and product integration commitments over the coming years.

“I am very satisfied that we have reached an agreement that is beneficial for both companies and that we have ended our legal disputes,” said Frans van Houten, CEO of Royal Philips in a press release. “Going forward, Philips and Masimo will completely focus on jointly delivering meaningful innovations to our customers.”

Philips and Masimo have agreed to jointly market and sell in North America and certain markets in Asia and Europe Masimo’s non-invasive sensor technologies, such as its rainbow and SET platforms, in conjunction with Philips’ patient monitoring and select therapy solutions.

Additionally, Philips will in the future integrate Masimo SedLine brain functioning monitoring, O3 regional oximetry and Nomoline capnography technologies in certain Philips IntelliVue monitors.

“This business partnership agreement marks an important day for us and our customers as two leaders in patient monitoring collaborate to develop solutions designed to enhance clinical outcomes and patient safety,” van Houten said.

Entering into the agreement has minimal impact on Philips’ income from operations in the fourth quarter of 2016, according to the release.

Masimo expects to use some of the after-tax proceeds from the agreement to repay amounts outstanding under its revolving line of credit, the release says.

Medtrade 2016: Industry gets down to business

HME News - Fri, 11/04/2016 - 10:55
Bid program permeated annual trade show, but attendees are determined11/04/2016HME News Staff

ATLANTA – With its core base of attendees small businesses, there was no way this year’s application of competitive bidding pricing to rural areas wasn’t going to have an impact on Medtrade.

But Show Director Kevin Gaffney said, while attendance was “lagging,” there were signs that those who did make the annual pilgrimage to Atlanta were committed to figuring out how to make the HME industry work.

“It seems like the rural roll-out has been more painful than other rounds of competitive bidding,” Gaffney said. “When it’s all said and done, there may be fewer providers, but I think there will be stronger providers and new providers with different business models.”

Provider Bob Elwood said he was at the show looking for partners who can help him grow his retail business, which makes up 30% to 40% of his total business.

“We’re looking for anything, everything, but mostly retail-related,” said Elwood, owner of Med City Mobility in Rochester, Minn. “We keep moving in that direction.”

Battle ahead

Lawmakers return Nov. 14 for a brief lame-duck session, and stakeholders say they have heard loud and clear that the HME industry needs relief, ideally in the form of a retroactive delay of a second round of Medicare reimbursement cuts that went into effect July 1.

“The HME market is disrupted like never before and the Hill is hearing it,” said Tom Ryan, president and CEO of AAHomecare during its Washington Legislative Update. “There’s the will and the interest to get something done, and the grassroots is so loud and that’s because of you in the room.”

Rep. Tom Price, R-Ga., reiterated the importance of communicating with lawmakers in remarks to attendees during a special appearance, noting that there is a lot at stake.

“Thirty-eight percent of DME suppliers have gone out of business since this craziness started,” he said. “Not because they chose to retire, but because the government has gotten engaged in the process. They’re picking the winners and losers. It’s so sad.”

A long-time supporter of the HME industry, Price also received an award from AAHomecare at the gathering.

The year of the woman

Two women took home prestigious awards at Medtrade this year.

Dr. Kirsten Davin, owner and president of Precision Seating Solutions, was awarded the inaugural HME Woman of the Year Award from the VGM Group at AAHomecare’s Washington Legislative Update.

Melissa Cross, vice president of the homecare division for O.E. Meyer in Sandusky, Ohio, was awarded the newly named Van Miller Homecare Champion Award from AAHomecare at the association’s Stand Up for Homecare reception.

Innovative products

Manufacturers also earned awards at the show in the biannual Innovative HME Retail Product Awards. Topricin BioMedical took first place with its MyPainAway Fibro Cream, an odorless, greaseless cream that seeks to relieve Fibromyalgia pain.

SoClean 2 CPAP Sanitizer by SoClean took second place and The Motivo Tour walker from Motivo placed third.

Best in show

For the Providers’ Choice Awards, the StandUp Walker from URise Products took the gold; the Handy Cane from the MOST Corporation took silver; and the Avid Rehab Vector Power Chair from Merits Health Products took bronze.

And finally two exhibitors received special recognition for their booths. The Creative Concept Booth Award went to Stander for its red carpet theme and the Best Booth Award went to ResMed for its dramatic lighting, creative spacing and large-form lifestyle murals/digital displays.

 

Competitive bidding update: CMS awards new contracts, finalizes changes to program

HME News - Fri, 11/04/2016 - 10:53
11/04/2016HME News Staff

WASHINGTON – CMS on Nov. 2 announced the contract suppliers for the latest round of its competitive bidding program.

For Round 1 2017, CMS says it has executed 182 contracts, 92% of the contracts it offered. The contracts will run from Jan. 1, 2017, through Dec. 31, 2018.

CMS says 92% of the contract suppliers are already established in the competitive bidding area, the product category, or both. It says 93% of small suppliers, those with gross revenues of $3.5 million or less, accepted offers.

Contract suppliers for each product category in each CBA can be found in the Supplier Directory at www.medicare.gov/supplier.

CMS announced the new single payment amounts for Round 1 2017 on Sept. 8.

Contract suppliers will see an overall reduction in Medicare reimbursement of 5.2% from the Round 1 re-compete to Round 1 2017, according to analysis by AAHomecare. The product categories with the steepest cuts* are TENS devices at 45.1%, followed by CPAP devices at 18.5%.

CMS finalizes changes to bid program

WASHINGTON – CMS issued a final rule Oct. 28 with a number of changes to competitive bidding, including establishing bid limits for future rounds of the program based on the fee schedule rates before they were adjusted.

Other changes:

·      Requiring bidding entities to obtain a bid surety bond from an authorized surety on the Department of the Treasury’s Listing of Certified Companies for each competitive bidding area associated with their bid. The bond must be finalized at $50,000 and must indicate the CBA specific to that bond.

·      Requiring that a contract will not be awarded to a bidding entity unless the entity meets applicable state licensure requirements. “This revision does not reflect a change in policy as CMS already has a regulation in place that requires suppliers to meet applicable state licensure requirements,” the agency stated.

·      Extending the appeals process to all breach-of-contract actions that CMS may take under the competitive bidding program, rather than just for contract termination actions. CMS will issue a notice of breach of contract, which will include any breach-of-contract actions the agency intends to take.

The final rule also includes a provision addressing inverted prices for similar items with different features under competitive bidding prior to adjusting fee schedule amounts paid in non-bid areas. CMS will use the weighted average of the prices for the similar items in a product category as the revised price for the items that will then be sued to adjust the fee schedule amounts.

CMS contractor expands phone demo

HME News - Fri, 11/04/2016 - 10:51
11/04/2016Liz Beaulieu

JACKSONVILLE, Fla. – C2C Innovative Solutions, the contractor handling the second level of the Medicare appeals process, has received the green light from CMS to expand a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases.

C2C, CMS’s Qualified Independent Contractor or QIC, received word from the agency on Nov. 1 that it can open the demo to all product categories, with the exception of power mobility devices, Daniel Roach, phone demo project manager, told HME News at Medtrade.

“The demo will still only apply to Jurisdictions C and D, and it will still only apply to claims from Jan. 1, 2013, up until current claims,” he said.

To date, C2C has been randomly selecting up to five claims per National Provider Identifier or NPI for two product categories: diabetes testing supplies and oxygen equipment.
C2C has conducted more than 4,000 calls and has re-opened close to 10,000 cases as of the end of October, Roach said.

“That’s 10,000 claims that have been removed from the ALJ,” he said. “They have been re-opened and made favorable.”

More providers could be taking advantage of the phone demo. Right now, only 60% of providers agree to go through the process when C2C notifies them by mail with a scheduled date and time for a phone conversation.

“That is increasing because of the outreach we’re doing,” said Emily Stroupe, education and outreach specialist.

For providers who outsource their billing to third parties, there has been confusion about who should be participating in the phone demo.

“Now we’re going to start working with the third parties directly,” Stroupe said.

C2C is not surprised CMS has decided to expand its phone demo.

“They’ve wanted to get more reversals done,” said Janet Lawrence, medical director for C2C.

Earnings: Invacare reports losses, Inogen raises guidance

HME News - Fri, 11/04/2016 - 10:49
11/04/2016HME News Staff

ELYRIA, Ohio – Invacare on Oct. 31 reported a net loss of $5 million for the third quarter of 2016 compared to $7.8 million for the same period last year. It reported net sales of $268.1 million vs. $283.8 million.

Invacare reported a net loss of $25.2 million for the nine months ended Sept. 30, 2016, compared to $23.3 million for the same period last year.

For North America HME, Invacare reported net sales of $98 million for the third quarter of 2016, a 14.5% decrease compared to the same period last year. For the nine months ended Sept. 30, it reported net sales of $314 million, a 12.5% decrease.

Invacare has acknowledged that as part of its transformation from a generalist to a specialized DME company, it would experience “periods of net sales declines.”

But Matthew Monaghan, chairman, president and CEO, says the company is making progress, citing the sale of its Garden City Medical business, which does business as PMI and Pinnacle Medsource; and the launch of two new products, the LiNX control system in Europe, a wirelessly programmable complex power wheelchair control system, and the Alber Twion power assist device for active manual wheelchairs users.

“In the quarter, we made the right kind of progress in our transformation, and had good uptake of our leading products, as well as positive response of our business associates and customers to these changes,” he said.

Inogen raises guidance

GOLETA, Calif. – Inogen on Nov. 3 reported total revenues of $54.4 million for the third quarter of 2016 compared to $40.8 million for the same period last year, a 33.5% increase. It reported net income of $3.5 million vs. $2.7 million, a 28.2% increase.

“We are very pleased with sales growth and execution across our business-to-business and direct-to-consumer channels this quarter, indicating increasing demand and adoption of our portable oxygen concentrators,” said Raymond Huggenberger, CEO.

Inogen reported 65.1% growth in domestic business-to-business sales for the third quarter, primarily driven by traditional home medical equipment provider purchases and the continued strength of its private label partner.

The company reported 38.6% growth in direct-to-consumer sales, approximately in line with expectations. It reported a 37.2% decrease in rental sales, largely due to a second round of Medicare reimbursement cuts that went into effect July 1, 2016.

As a result of its year-to-date results, Inogen has increased its revenue guidance for 2016 to $194 million to $198 million, representing year-over-year growth of 22% to 24.5%. It has also increased its revenue guidance for 2017 to 2017 to $230 million to $236 million.

In brief: CMS names nat’l RAC for DME, whistleblower drops lawsuit against Lincare

HME News - Fri, 11/04/2016 - 10:46
11/04/2016HME News Staff

WASHINGTON – CMS has tapped Performant Recovery to perform post-payment reviews of Medicare claims for DMEPOS and home health/hospice nationwide.

The other RACs awarded contracts will perform post-payment reviews to identify and correct Medicare claims that contain improper payments that were made under Part A and Part B for all provider types other than DMEPOS. Performant Recovery also won that contract for Region 1. Cotiviti won contracts for Region 2 and 3, and HMS Federal Solutions won a contract for Region 4.

CMS planned to have new RACs in place in 2014, but several of its awards were contested.

CMS originally announced in 2015 that it had tapped Connolly as the national RAC for DME.

AHP closes patient contact center in Texas

BRENTWOOD, Tenn. – American HomePatient will lay off 98 employees in Longview, Texas, by Dec. 31, according to the Longview News-Journal. AHP is closing its patient contact center there, consolidating operations in Nashville. The center employed 142 people in June, down from 160 in February, according to the newspaper. AHP expanded into Longview five years ago after the Longview Economic Development Corp. extended a seven-year, $1.1 million incentive. AHP promised to employ 220 people by 2015, according to the newspaper. “I have spoken to them,” LEDCO President and CEO Wayne Mansfield told the newspaper. “There have been a significant number of changes on how Medicare reimburses its participants. It’s drastically affected their bottom line.”

Whistleblower drops lawsuit against Lincare

CLEARWATER, Fla. – A former billing specialist has voluntarily dropped her False Claims Act lawsuit against Lincare, according to Law360. In a one-page order, U.S. District Judge Mary Scriven granted Rebecca Saiff’s request to dismiss the lawsuit, a request that was granted without prejudice to either Saiff or the U.S. government, which declined to intervene, according to the legal publication. Saiff had filed a lawsuit alleging that Lincare has been knowingly defrauding the government of millions of dollars by billing false claims to Medicare. She worked for Lincare at its corporate headquarters from January to July 2013, and at its Largo, Fla., regional billing and collection office from August 2013 to February 2014. She filed her lawsuit under seal in April 2014.

Va., N.C. move to regional association

CARY, N.C. – The Virginia Association of Durable Medical Equipment Companies (VADMEC) and the North Carolina Association of Medical Equipment Services (NCAMES) have combined to form the Atlantic Coast Medical Equipment Suppliers (ACMESA). The executive director of both associations, Beth Bowen, made the announcement on twitter on Nov. 3. Bowen owns an association management company named TayCar, Inc. Bowen also leads the Florida Association of Home Care Services (FAHCS) and, earlier this year, she took the helm of the Association for Tennessee Oxygen & Medical Equipment Services (ATHOMES).

Drive extends warranty

PORT WASHINGTON, N.Y. – Drive DeVilbiss Healthcare has extended its warranty on all scooters and power chairs. Effective Nov. 1, new scooter and power chair purchases from Drive DeVilbiss will have a 12-month warranty on batteries, and a 24-month warranty on electronics. Scooters and power chairs will continue to have a limited lifetime warranty on the main frame. “Implementing this extended warranty for all our scooters and power chairs speaks to the confidence and pride we have in these products,” said Brandon Sykes, product manager-power and manual wheelchairs for Drive DeVilbiss.

ResMed enhances AirView’s features

SAN DIEGO – ResMed has enhanced AirView, its cloud-based remote patient monitoring platform, to include action groups, allowing clinicians to filter sleep apnea patients into groups based on adherence status or a specific therapy issue. This new “manage by exception” feature will reduce the time clinicians spend on back-office paperwork and processes, and will help ensure that patients get the most responsive and quality treatment, the company says. Action Groups are based on a similar feature in U-Sleep—another ResMed monitoring tool— that reduced clinicians’ patient management time by 59%, the company says.

AllegroMedical: 20 years strong

BOLINGBROOK, Ill. – AllegroMedical.com, an online medical supply company, is celebrating 20 years in business. “Our first website offered 500 products,” said Craig Hood, founder, in a press release. “Today, we offer more than 60,000 products to help people manage chronic conditions from diabetes and incontinence, to spinal cord injuries and COPD.” AllegroMedical.com serves 2 million customers, according to the release.

Livingston Innovations receives award for Freedom Trax

CHICAGO – Livingston Innovations of Waukegan, Ill., has been named one of the winners of the 15th annual Chicago Innovation Awards. The company’s Freedom Trax is a powered track attachment for manual wheelchairs that allows users to maneuver through sand, snow, grass and other off-road conditions. “We are honored to receive such a prestigious award,” said Troy Livingston, president. “Our team has worked tirelessly to provide a device that can help people get outside and experience the outdoors.” Winners receive a variety of honors, including the opportunity to ring the NASDAQ Bell in New York City.

Amoena, Juzo line up annual symposium

LAS VEGAS – The lineup for the 2017 POWER Symposium from Amoena and Juzo is taking shape, with a keynote address by Libby Gill, executive coach, brand strategist and bestselling author. The event, Feb. 23-25 at the Paris Hotel here, will also feature billing and insurance guidance from healthcare attorney Jeff Baird, profitable selling strategies from Christine Gifford, and inspiration from Jane Jenkins Herlong. Register by Dec. 31 for an $85 early-bird discount.

Inogen raises guidance

HME News - Fri, 11/04/2016 - 08:25
11/04/2016HME News Staff

GOLETA, Calif. – Inogen on Nov. 3 reported total revenues of $54.4 million for the third quarter of 2016 compared to $40.8 million for the same period last year, a 33.5% increase. It reported net income of $3.5 million vs. $2.7 million, a 28.2% increase.

“We are very pleased with sales growth and execution across our business-to-business and direct-to-consumer channels this quarter, indicating increasing demand and adoption of our portable oxygen concentrators,” said Raymond Huggenberger, CEO.

Inogen reported 65.1% growth in domestic business-to-business sales for the third quarter, primarily driven by traditional home medical equipment provider purchases and the continued strength of its private label partner.

The company reported 38.6% growth in direct-to-consumer sales, approximately in line with expectations. It reported a 37.2% decrease in rental sales, largely due to a second round of Medicare reimbursement cuts that went into effect July 1, 2016.

As a result of its year-to-date results, Inogen has increased its revenue guidance for 2016 to $194 million to $198 million, representing year-over-year growth of 22% to 24.5%. It has also increased its revenue guidance for 2017 to 2017 to $230 million to $236 million.

CMS awards new contracts

HME News - Wed, 11/02/2016 - 15:20
11/02/2016HME News Staff

WASHINGTON – CMS on Wednesday announced the contract suppliers for the latest round of its competitive bidding program.

For Round 1 2017, CMS says it has executed 182 contracts, 92% of the contracts it offered. The contracts will run from Jan. 1, 2017, through Dec. 31, 2018.

CMS says 92% of the contract suppliers are already established in the competitive bidding area, the product category, or both. It says 93% of small suppliers, those with gross revenues of $3.5 million or less, accepted offers.

Contract suppliers for each product category in each CBA can be found in the Supplier Directory at www.medicare.gov/supplier.

CMS announced the single payment amounts for Round 1 2017 on Sept. 8.

Contract suppliers will see an overall reduction in Medicare reimbursement of 5.2% from the Round 1 re-compete to Round 1 2017. The product categories with the steepest cuts are TENS devices at 45.1%, followed by CPAP devices at 18.5%.

CMS taps Performant for nat’l RAC for DME

HME News - Wed, 11/02/2016 - 10:39
11/02/2016HME News Staff

WASHINGTON – CMS has tapped Performant Recovery to perform post-payment reviews of Medicare claims for DMEPOS and home health/hospice nationwide.

The other RACs awarded contracts will perform post-payment reviews to identify and correct Medicare claims that contain improper payments that were made under Part A and Part B for all provider types other than DMEPOS. Performant Recovery also won that contract for Region 1. Cotiviti won contracts for Region 2 and 3, and HMS Federal Solutions won a contract for Region 4.

CMS planned to have new RACs in place in 2014, but several of its awards were contested.

CMS announced in 2015 that it had tapped Connolly as the national RAC for DME.

The year of the woman

HME News - Tue, 11/01/2016 - 13:36
Davin, Cross sweep awards at Medtrade11/01/2016Liz Beaulieu

ATLANTA – Two women took home prestigious awards at Medtrade this year.

Dr. Kirsten Davin, owner and president of Precision Seating Solutions, was awarded the inaugural HME Woman of the Year Award from the VGM Group at AAHomecare’s Washington Legislative Update on Tuesday morning. The award honors a woman who has made increasingly significant contributions throughout her career to both her company and the HME industry.

Davin’s long list of accomplishments includes founding Precision Seating Solutions, a company that manufactures affordable pressure mapping systems for wheelchairs; creating a series of long-running seminars on wheelchair seating and positioning called “Let’s Roll” and “Hands On”; and serving as a volunteer firefighter, EMT and medical training officer for the Pleasant Plains Fire Department.

“Kirsten is the epitome of a leader,” said Robert Schafer, fire chief for the Pleasant Plains Fire Department, in his nomination of Davin. “She sets a goal, finds a way and achieves.”

Davin’s father, Richard Kinner, who also nominated her for the award, said, “Dr. Davin is the great American success story.”

The finalists for the HME Woman of the Year Award were Davin; Rose Schafhauser, owner of Association Management, who serves as executive director for MAMES, AZMESA and WAMES; Laurie Tomaszewski, chief sales and marketing officer for Handi Medical Supply; and Patricia Mastandrea, COO of MedCare Equipment Company.

VGM received 37 nominations for the award.

Melissa Cross named champion

On Tuesday night, Melissa Cross, vice president of the homecare division for O.E. Meyer in Sandusky, Ohio, will be awarded the newly named Van Miller Homecare Champion Award from AAHomecare at the association’s Stand Up for Homecare reception. The award honors an AAHomecare member who has made exceptional contributions to the homecare community throughout their careers.

Cross has been involved with the Ohio Association of Medical Equipment Services for 18 years, including a stint as president right before CMS was launching its competitive bidding program in nine cities, two of them in her state.

“We’re probably going through the biggest battle of our lives with the bidding program,” said Cross, who has worked for O.E. Meyer for 22 years. “And what AAHomecare, VGM and others are doing for this industry—they’re the true winners of this award. They’re in the trenches day in and day out. We have to step up so their work means something.”

The Van Miller Homecare Champion Award was renamed to reflect the characteristics of HME visionary Van Miller, past CEO and founder of the VGM Group, who passed away in October of 2015.

Last year’s Homecare Champion Award went to the Tart brothers, Joey and Billy, co-founders of Family Medical Supply in Dunn, N.C.

CMS finalizes changes to bid program

HME News - Fri, 10/28/2016 - 19:36
10/28/2016HME News Staff

WASHINGTON – CMS issued a final rule Oct. 28 with a number of changes to competitive bidding, including establishing bid limits for future rounds of the program based on the fee schedule rates before they were adjusted.

“This will avoid a downward trend where the new, lower bid limits apply to each subsequent round of bidding based on fee schedule rates adjusted using bidding information from the previous round,” the agency stated. “This will help enhance the long-term viability of the program and allow suppliers to take into account both decreases and increases in costs in determining their bids, while ensuring that payments under the program do not exceed the amounts that would otherwise be paid had the program not been implemented.”

Other changes to competitive bidding in the rule:

  • Requiring bidding entities to obtain a bid surety bond from an authorized surety on the Department of the Treasury’s Listing of Certified Companies for each competitive bidding area associated with their bid. The bond must be finalized at $50,000 and must indicate the CBA specific to that bond.
  • Requiring that a contract will not be awarded to a bidding entity unless the entity meets applicable state licensure requirements. “This revision does not reflect a change in policy as CMS already has a regulation in place that requires suppliers to meet applicable state licensure requirements,” the agency stated.
  • Extending the appeals process to all breach-of-contract actions that CMS may take under the competitive bidding program, rather than just for contract termination actions. CMS will issue a notice of breach of contract, which will include any breach-of-contract actions the agency intends to take.

The final rule also includes a provision addressing inverted prices for similar items with different features under competitive bidding prior to adjusting fee schedule amounts paid in non-bid areas. CMS will use the weighted average of the prices for the similar items in a product category as the revised price for the items that will then be sued to adjust the fee schedule amounts.

Responding to the final rule, the Council for Quality Respiratory Care said it was pleased CMS will implement bid limits based on the previous fee schedule for future rounds of the program, but it continues to believe there are “fundamental problems” with the program that need to be addressed before rates were applied in non-bid areas.

“It is imperative that Congress fix this problem by reinstating the phase-in of the new rates in non-competitive bidding areas and require CMS to engage with stakeholders to reconsider methodology for setting rates in non-competitive bidding areas,” it stated.

Syndicate content