In brief: AAH ‘embraces’ e-prescribing, Medicare Advantage gets 3.4% increase

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Friday, April 6, 2018

WASHINGTON – AAHomecare’s Executive Committee will examine e-prescribing platforms to recommend the best solution for its provider members.

“It’s time for the HME community to move away from the fax machine and individual paper prescriptions, and fully embrace e-prescribing,” said Steve Ackerman, AAHomecare chairman and president of Spectrum Medical, in a bulletin. “Companies that invest in e-prescribing will be able to fill orders more efficiently to the benefit of patients and caregivers, while also reducing documentation errors and audits.”

AAHomecare will study leading e-prescribing platforms in terms of their suitability for the HME sector and recommend the best solutions. The association will subsequently work with companies supplying these platforms to provide additional guidance and to help promote the industry’s use of this technology.

“The healthcare field is rapidly moving toward increased usage of electronic communications and record keeping, and HME suppliers need to keep up,” said Ackerman. “While our companies will always rely on dedicated professionals to make sure that our patients are receiving a high standard of care, we also need to automate processes wherever it makes sense to do so.”

Medicare Advantage gets 3.4% increase

WASHINGTON – CMS will increase average payments for health insurers that manage Medicare Advantage plans by 3.4% for 2019, the agency announced on April 1. CMS initially proposed a 1.84% increase, according to news reports. The agency will also make a number of policy changes to MA plans, including codifying key aspects of the Star Ratings system and revising the regulations controlling maximum out-of-pocket limits.

VGM joins work group on electronic medical documentation

WATERLOO, Iowa – The VGM Group and its membership has been invited to participate in a CMS work group on electronic medical documentation. VGM will represent DMEPOS providers in the work group, which will have representation from several different provider groups. “While the concept of electronic medical records is not new, this initiative of utilizing technology to allow providers the opportunity to easily communicate and receive proper patient documentation is something that the DME industry struggles to gain from other provider communities,” VGM stated. “We look forward to sharing the developments and engaging with our membership to offer proper feedback as these standards are set.” The work group seeks to, among other things, establish pilot programs with providers to demonstrate secure exchange of health information, and support adoption of real-world use cases to advance secure and standardized electronic data exchange for medical documentation requests and responses.

Oklahoma providers meet with Rep. Cole

NORMAN, Okla. – Members of the Oklahoma Medical Equipment Providers Association and the VGM Group hosted Rep. Tom Cole, R-Okla., at an event at Norman Regional Home Medical Equipment. Members discussed how DME and complex rehab providers care for patients. Cole was especially interested in the industry’s efforts to keep patients in their homes. Also of interest: the flaws of Medicare’s competitive bidding program, as his district falls within the Oklahoma City bid area. Jason Price of the Oklahoma Department of Rehabilitation Services, who has cerebral palsy and uses a wheelchair, was there to discuss with Cole the importance of people with disabilities being able to lead active lives and contribute to their communities. “There are already enough obstacles for disabled employees to overcome in pursuing a career,” he said. “I do not want to see more obstacles because they don’t have access to this equipment they depend on.”

CMS officials on docket for Heartland

WATERLOO, Iowa – CMS officials will participate in a panel discussion at VGM’s Heartland Conference. CMS Competitive Bidding Acquisition Ombudsman Tangita Daramola and Small Business Administration Deputy National Ombudsman Natalie Dunca, along with contractors from CGS, C2C and Noridian, will participate in the 90-minute session. “VGM has maintained a working relationship with Tangita and her staff at CMS in an effort to improve CMS programs and keep DME suppliers informed of CMS updates,” stated Ronda Buhrmester, VGM’s reimbursement expert and session moderator. “By bringing them to the Heartland Conference, members will have the opportunity to share firsthand how regulations, reimbursements and audits are affecting their business.” This year’s Heartland Conference takes place June 19-21. FMI: www.vgmheartland.com.

Regulatory updates: Low volume appeals, prior auths

CMS will be accepting expressions of interest for low volume appeals from April 12-June 8, 2018, for all NPIs. An EOI must be submitted for each NPI. The appeals are only offered to appellants that have less than 500 appeals sitting at OMHA and/or the Medicare Appeals Council as of Nov. 3, 2017, and each appeal must have a total billed amount of $9,000 or less. More information can be found here*…CMS has removed the following items from the prior authorization Master List: hospital bed semi-electric (E0260); CPAP (E0601); oxygen concentrator (E1390); and wheelchair (K0004). CMS is required to adjust the payment threshold for inflation annually. The payment threshold is $1,018 or greater, or an average monthly rental of $102 or greater. The four items did not meet the payment threshold.

Ascensia expands access for Contour products

BASEL, Switzerland – Ascensia Diabetes Care has improved access to its Contour Next meters and test strips for UnitedHealthcare members, it announced today. Effective April 1, individuals can access the brand’s products through their pharmacy benefit at a tier 2 co-pay level. Previously, a prior authorization was required. “This change will give more people the opportunity to access these products, and at a reasonable cost,” said Robert Schumm, vice president and managing director of Ascensia Diabetes Care US.

AOPA’s Fise to step down

ALEXANDRIA, Va. – Tom Fise will step down from his role as executive director of the American Orthotic & Prosthetic Association when his contract expires at the end of 2018. “On behalf of AOPA, I would like to thank Tom for his dedication and commitment to the orthotic and prosthetic industry,” said Jim Weber, president of AOPA, in a press release. “His legislative and regulatory experience has been most valuable to AOPA as he has worked to champion our association’s needs to Congress, CMS and other regulatory bodies.” Fise has been with AOPA nearly 12 years. AOPA’s executive committee has appointed a seven-member search committee to find Fise’s successor. It has also engaged Sterling Martin Associates, a leading national executive search firm, to guide the process. Sterling Martin focuses exclusively on the association and nonprofit sectors, and has significant experience in the healthcare space. AOPA anticipates filling the position by the end of August, allowing sufficient time for a successful transition of leadership.

VMI exec to receive recognition

ALEXANDRIA, Va. – Tim Barone, president and CEO of Vantage Mobility International, will receive a 2018 Distinguished Service Award from the Military Officers Association of America at an event on Capitol Hill in April. The award is given in recognition of contributions to the military community. Past recipients include Tom Brokaw and Colin Powell. Military Officers Association of America (MOAA) is the nation's largest military officers' association with more than 350,000 members from every branch of uniformed service, including active duty, retired, National Guard, Reserve, and former officers and their families and survivors.

ResMed names Ghoshal CTO

SAN DIEGO – ResMed didn’t have to look far to find its first chief technology officer. The company announced April 2 that it had named Bobby Ghoshal as CTO. Ghoshal had been the COO of Brightree, which ResMed bought in 2016. In his new role, Ghoshal will lead ResMed’s global healthcare informatics and data analytics team to drive its cloud-based digital health platforms, as well as investments in emerging health technologies like artificial intelligence and machine learning. Prior to his role at Brightree, Ghoshal was vice president of information technology at ResMed. Raj Sodhi, who is currently president of software-as-a-service businesses at ResMed, had previously led the company’s healthcare informatics team. “I’m excited for Bobby’s return to the ResMed team,” Sodhi said. “With Bobby as CTO, I can be fully focused on expanding the capabilities of ResMed’s SaaS solutions for out-of-hospital care, while Bobby leads the next level of tech innovation, investments and partnerships that will take our digital health capabilities to new frontiers, for the ultimate benefit of patients, physicians, providers and payers.”

AADE releases tip sheet for mail-order diabetes program

CHICAGO – The American Association of Diabetes Educators has released a tip sheet for navigating Medicare’s national mail-order program for diabetes testing supplies. The tip sheet, which was developed by the AADE’s Professional Practice Committee, provides information on: what is the program, why has it caused concern and what can diabetes educators do to help. The tip sheet recommends that diabetes educators explain the program and how it works to people with diabetes; walks them through the CMS website, which can be overwhelming; write “no substitutions” on prescriptions for those that require a particular brand for a significant reason; encourage those who are sent incorrect supplies to call 1-800-Medicare or the fraud hotline of the Office of Inspector General; and point out that if their brand isn’t available through the program they may purchase supplies at their local pharmacy, if the pharmacy accepts Medicare reimbursement and assignment, with a 20% coinsurance after the Part B deductible is met.

Byram Healthcare signs up for eOrdersPlus

CARMEL, Ind. – Byram Healthcare will participate in the Preferred Supplier Program with Stratice Healthcare. As part of the program, Byram will use Stratice’s eOrdersPlus solution to better serve its physician partners and patients with their medical supply needs in urology, diabetes, wound care, ostomy and incontinence. The solution’s direct electronic connectivity replaces an otherwise inefficient, largely paper-based ordering process, the companies say. “eOrdersPlus will help improve health data exchange between prescribers and suppliers, resulting in operational efficiencies and improved patient care,” said Perry Bernocchi, CEO of Byram. eOrdersPlus is available to healthcare providers and prescribers through direct integration with electronic healthcare record systems used in the practice setting, as well as through a HIPAA-secured web-based portal for use by all physicians and their staff.