In brief: CMS solicits input on reimbursement, nat’l RAC ready to roll

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Friday, March 10, 2017

WASHINGTON – CMS has scheduled a call to solicit stakeholder input on its methodology for using information from the competitive bidding program for adjusting Medicare fee schedule amounts in non-bid areas.

The 21st Century Cures Act mandated that the agency solicit and take into account stakeholder input on future pricing in non-bid areas.

The act also mandated that CMS take into account the highest amount bid by a winning supplier in a bid area, as well as make comparisons in bid and non-bid areas for the average travel distance and costs associated with furnishing items and services in an area; the average volume of items and services furnished by suppliers in the area; and the number of suppliers in the area.

The call is scheduled for March 23 from 2 p.m. to 3:30 p.m. EST. Register here.

Stakeholders may also submit written comments at DMEPOS@cms.hhs.gov.

CMS schedules call for PA process

WASHINGTON – After two cancellations, CMS has scheduled a Special Open Door Forum to discuss the prior authorization process for two complex rehab codes.

The agency’s Center for Program Integrity will host the first in a series of Special Open Door Forums on March 16 to invite suppliers, physicians and other Medicare practitioners or interested parties to discuss the implementation of the prior authorization process for K0856 and K0861. CMS began accepting prior authorization requests for these two codes on March 6 for dates of delivery on March 20.

CMS cancelled a previous Special Open Door Forum on this topic scheduled for January. It then removed the topic from the agenda of a general Open Door Forum in February.

During the forum, CMS says it will outline the process for submitting a prior authorization request to the designated Medicare Administrative Contractor, the timeframes for the MAC to render their prior authorization decisions, and the process for subsequent claims submissions.

To participate in the forum, scheduled from 2 p.m. to 3:30 p.m. EST, dial 800-837-1935 and use the ID 85144406.

HHS still says it can’t meet appeals deadline

WASHINGTON – The Department of Health and Human Services says it won’t meet a deadline to clear a backlog of appeals unless it settles the claims without seeing if they have merit.

In a status report, HHS told the D.C. Circuit court that its 687,382-claims backlog is projected to reach more than 1 million by the end of fiscal year 2021, according to Law360. The agency made a similar claim in February, saying it needed more money and cooperation from the provider community.

“Although the initiatives undertaken by HHS have significantly slowed the growth of the backlog, the significant annual reductions that this court has directed are not possible given current funding and legislative authorities,” HHS says.

The report also states that the Office of Medicare Hearings and Appeals would “violate its statutory obligations if it were to resolve cases without deciding them on the merits.”

HHS was ordered in December 2016 to find a way to reduce the backlog of cases at the Administrative Law Judge level by 30% at the end of 2017; 60% at the end of 2018; 90% at the end of 2019; and completely by the end of 2020.

Making things more challenging, HHS says: Hospitals and providers haven’t been as receptive to an initiative to settle claims as predicted.

Performant ready to roll

LIVERMORE, Calif. – Performant Recovery, the new national recovery audit contractor for DMEPOS and home health/hospice, announced March 8 that it has officially received approval from CMS to begin audit activity. The RAC in February posted seven new reviews on its workload page: complex medical necessity chest wall oscillation devices; complex medical necessity tracheotomy suction catheters, suction pumps, catheters and other related supplies and equipment; automated nebulizers not in accordance with billing requirements; automated DME billed while inpatient; complex review osteogenesis stimulators; automated CPM billed without total knee replacement; and complex Group 2 support surfaces without correct diagnosis of condition.

Two longtime complex rehab advocates honored

NASHVILLE, Tenn. – Michele Gunn of Browning’s Pharmacy and Health Care, and Gerry Dickerson of National Seating and Mobility were named the inaugural recipients of the Simon Margolis Fellow Award at the International Seating Symposium this month. Gunn, a NRRTS registrant since 1996, currently serves on the NRRTS and NCART boards, and the Professional Standards Board. Dickerson, a NRRTS registrant since 1994, currently serves on the NRRTS Executive Board. Margolis, a longtime leader in the complex rehab industry, passed away in July 2016. This year also marks the 25th anniversary of NRRTS.

New York reduces cut for incontinence supplies

ALBANY, N.Y. – The New York Department of Health has announced an average reduction of 20% for incontinence supplies, according to a bulletin from AAHomecare. Previously, it had proposed a 30% reduction, but AAHomecare and the Northeast Medical Equipment Providers Association expressed concerns regarding the unsustainability of the cuts. The new rate takes effect April 3.

VMI names sweepstakes winner

CHEYENNE, Wyo. – Vantage Mobility International has named Michael Gallagher as the winner of its Claim More Space Sweepstakes. Gallagher, who suffers from degenerative spine disease, has a VMI Northstar side-entry in-floor conversion for wheelchair access to his 2016 Toyota Sienna. Gallagher, who was chosen from more than 7,000 entries, received $10,000 plus a year’s supply of gasoline. “We are proud to provide wheelchair accessible solutions to improve the quality of life for others,” said Doug Eaton, VMI president and CEO. “In Michael’s case, being the VMI Claim More Space Sweepstakes winner, the dependability of the conversion provides him with the freedom to travel and live to the fullest.”

SoClean releases new video

OXFORD, Mass. – SoClean recently launched the latest installment in its educational video series, “The Bacteria Family Reunion,” aimed at increasing awareness of the value of its CPAP cleaning machine. The animated video is also part of SoClean’s spring giveaway, which will award one winner a free SoClean machine. Deadline for the contest is March 31, 2017, at midnight PST. Go to: https://www.soclean.com/soclean-cpap-signup/.

Philips expands Dream family of respiratory devices

AMSTERDAM, the Netherlands – Royal Philips has expanded its Dream Family of products with the DreamStation Advanced Therapies BiPAP autoSV and AVAPS devices to provide care for patients with complex ventilation needs. The devices are currently available in select markets in the U.S., France and Australia, and will be available globally by the end of this year. They aim to deliver optimal ventilation with minimal intervention so patients experience comfortable, restful sleep and quality of life. The DreamStation Advanced Therapies devices are fully integrated through the Philips Encore Anywhere patient management tool, providing automated support for the patient’s changing needs, as well as remote monitoring capabilities support for physicians, HME providers and caretakers to intervene when needed to minimalize adverse effects. The Dream Family of products launched in 2015 as a full suite of sleep solutions that connect and support the patient, clinician and homecare provider to enhance patient care and quality of life.

Short takes: Ryan French

Ryan French, director of Jim’s Pharmacy & Home Health in Port Angeles, Wash., recently received the 2016 Ambassador Award from Brightree. The award is given to an individual with the greatest involvement and contributions to the Brightree Online Community. French’s contributions include helping to improve software design, answering questions, troubleshooting problems, providing best-practice recommendations and gathering information from other companies.