In brief: Proposed rule includes home infusion changes, OIG report reviews ‘place-of-service’ claims

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Tuesday, July 3, 2018

WASHINGTON – Temporary transitional payments for home infusion therapy are moving forward, according to an upcoming proposed rule.

The rule, which will be published in the July 12 Federal Register, contains information on the implementation of the payments, which will fix a payment gap created by the 21st Century Cures Act. The Cures Act requires Medicare to pay for services associated with providing Part B home infusion drugs, but not until 2021.

The temporary payment, which was passed as part of a government spending bill in February, takes effect Jan. 1, 2019.

The proposed rule also seeks comments on elements of a new home infusion therapy benefit category, proposes standards for home infusion therapy suppliers, and proposes an oversight process for organizations that accredit home infusion suppliers.
 

OIG to CMS: Take stronger look at ‘place-of-service’ claims
WASHINGTON – CMS’s edits didn’t detect $18.4 million in payments in 2015 for inappropriate claims for DME provided during non-covered stays in skilled-nursing facilities, according to a report from the Office of Inspector General.

This represents 6% of all payments for DME during non-covered stays in SNFs, the OIG says.

CMS uses two edits that are designed to identify and reject such claims, but neither edit rejected the claims because SNFs and DME suppliers did not submit full and accurate information required for processing, according to the OIG.

The report found:
•    For 72% of inappropriate claims, DME suppliers failed to correctly code the SNF as a facility. Instead, they coded the place of service as the beneficiary’s home, thus enabling the claims to bypass the edit that rejects separate payment for most DME provided at facilities. By definition, SNFs provide primarily skilled care and thus cannot be considered beneficiary homes.
•    For 98% of the inappropriate claims, SNFs did not submit “payment bills,” which are administrative claims that document the dates of non-covered stays and do not result in payment. No-payment bills enable another CMS edit to identify non-covered stays and reject claims for DME provided during those timeframes.

CMS may have also allowed up to $3.7 million in Medicare payments for inappropriate claims for DME provided during stays in Medicare-only nursing facilities.

The OIG recommends that CMS 1.) strengthen oversight of place-of-service codes by developing a process to determine whether DME claims with “home” as the place of service fit the circumstances permitting separate payment; 2.) assess the costs and benefits of strengthening oversight of no-payment bills by developing a process to identify non-covered stays when SNFs do not submit no-payment bills; and 3.) assess the costs and benefits of collecting and maintaining information regarding the level of care provided by Medicaid-only nursing facilities.

CMS concurred with the OIG’s recommendations.

Compass Health, NDC increase services to Midwest
CLEVELAND – Compass Health has entered into a Preferred Vendor Partnership with NDC Homecare, a regional distributor to HME providers in the Midwest. The partnership means providers in Arkansas, Iowa, Kansas, Missouri, Nebraska and Oklahoma can now enjoy next-day delivery, lower freight minimums and will-call service, something they never had access to before due to how far they were from Compass Health’s distribution centers. “We have been exploring ways to improve our level of service to HME dealers that are not strategically located near one of our distribution centers,” said Gregory Zenko, senior vice president of HME for Compass Health. “This partnership is a win-win for all—Compass Health, NDC Homecare and the smaller HME dealer who historically couldn’t meet the freight minimum required for next-day delivery because of location.” NDC has distribution facilities in Conway, Ark., and Kansas City.

Philips Sleep and Respiratory taps Pittsburgh for new headquarters
PITTSBURGH – Philips Sleep and Respiratory Care has reached an agreement with Walnut Capital Partners to acquire 20,000 square feet of space in a new $30 million, nine-story office building being built in Pittsburgh, according to the Post-Gazette. Philips, which currently headquarters this business in Murrysville, Pa., plans to relocate about 1,250 of 1,700 employees in the region to the new building, the newspaper reported. The company plans to keep its manufacturing, distribution and service associates and facilities at the current Westmoreland County locations, according to the Post-Gazette. Philips says the building puts the company closer to universities like Carnegie Mellon and the University of Pittsburgh, UPMC medical centers, research partners and other innovation leaders in the region, the newspaper reported.

VMI gives military athletes a lift
PHOENIX – Vantage Mobility International served the military community for two weeks in June for the Department of Defense’s Warrior Games at the U.S. Air Force Academy in Colorado Springs, Colo. For the second year in a row, VMI, a manufacturer of wheelchair accessible vehicles, was a sponsor of the Games, providing accessible transportation for athletes and coaches. This year, 14 VMI drivers used seven minivans to transport dozens of active-duty service members and veteran athletes for a total of 8,273 miles. VMI remained on-call to offer transportation 16 hours a day for 14 days to bring participants to competitions, practice fields and six hotels. An additional two-dozen VMI employees worked behind the scenes to ship, prepare and maintain vehicles, coordinate logistics, and juggle all the accounting, production and operation needs to keep vehicles running. The DoD Warrior Games were established in 2010 to enhance the recovery and rehabilitation of wounded, ill and injured service members and expose them to adaptive sports. In 2018, more than 300 athletes competed from all branches of the U.S. Military, as well as armed forces from the United Kingdom, Australia and Canada. The competition awarded 608 medals to athletes in 11 sports including archery, cycling, sitting volleyball, shooting, swimming, powerlifting, wheelchair basketball and more.

Quantum, Pride offer CEUs at Medtrade
ATLANTA – Quantum Rehab and Pride Mobility Products will offer CEUs for two classes at Medtrade: “The Case for Wheels: Selecting the Clinically Appropriate Base,” and “Clinically Speaking—Evaluation and Documentation for Power Seating Options.” Each class offers 0.20 CEUs at no charge. The classes will be lead by Julie Piriano, PT, ATP/SMS, vice president of clinical education, industry affairs and compliance officer for Quantum Rehab and Pride Mobility Products, and are designed to be interactive. “Instead of putting away their cell phones, attendees will be using them throughout the classes,” she said. “They will be voting on answers to questions and gauging perceptions. We will compare their perceptions of drive wheel configuration (during the “Case for Wheels”) with colleagues throughout the Unites States and Canada.” Medtrade takes place Oct. 15-17 at the Georgia World Congress Center in Atlanta.

Permobil Foundation, NSM donate wheelchair
NASHVILLE, Tenn. – The Permobil Foundation and National Seating & Mobility teamed up with Lain’s parents to get him in a new Permobil wheelchair in time for his 17th birthday and his Junior Prom. The chair, a Permobil F5 Corpus VS, features a vertical stander, allowing Lain to dance at the prom. “I will say, I have held it together all of this time, but when I saw him standing with his friends for the first time, I became very emotional,” said Lain’s mom. “He was at their height and smiling from ear to ear. I am beyond excited for all this has done for Lain and our family.” The icing on the cake: Lain and his date were named Prince and Princess of the prom. The Permobil Foundation is the philanthropic arm of Permobil.

People news: Michael Rozaieski
Cape Coral, Fla.-based Merits Health Products has hired Michael Rozaieski as director of product development. Rozaieski, who previously worked for Quantum Rehab, Curtis Instruments and Fuller Rehabilitation, has more than 20 years of experience in product research and development, and sales. He will be responsible for product development across the Merits, Avid (complex rehab) and Pilot (home access) product lines.