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Executive Session

by: Mike Moran - Tuesday, November 17, 2009

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The Golden Boys movie Here's a resource that may help bring your physician referral sources up to speed on PECOS. It's a new Web site created by HME provider Chris Rice. I clicked around the site last week, and it's very clear and easy to understand.

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Here's some more information and a link to the site.

RIVERSIDE, Calif. – HME provider Chris Rice has created a Web site that other providers can use to show their physician referral sources how to comply with the Provider Enrollment, Chain and Ownership System (PECOS).

“It’s all CMS’s information,” said Rice, director of marketing for Diamond Respiratory Care, in Riverside. “It’s just combined in an easier to find, more manageable site.”

Rice developed the site after discovering that most doctors know nothing about PECOS, and once they did learn about it, “we had nowhere to send them.” The site explains what PECOS is and helps doctors enroll in PECOS.

It also explains how the program will impact providers and patients. Much is at stake with PECOS: Starting Jan. 4, 2010, CMS will begin rejecting claims that include the names and NPI numbers of physicians and non-physician practitioners that aren’t listed in the system.

– Mike Moran

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by: Mike Moran - Monday, November 16, 2009

Hannibal Rising the movie The Associated Press published a second article over the weekend about Medicare fraud.

It turns out that, for the most part, CMS turned a blind eye when, over a period of three years, it received more than 30 warnings from inspectors of fraud infiltrating the Medicare program. The AP was fed the story by Sen. Chuck Grassley, R-Iowa.

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Despite the lapses, Obama's Health and Human Services Secretary Kathleen Sebelius said the Centers for Medicare and Medicaid Services typically responds to fraud warnings promptly, and has investigated more than 300 since 2006. She was not satisfied that all fraud alerts were receiving sufficient responses and her office is implementing a new process for tracking the red flags.

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Grassley wants the agency to respond to future fraud warnings within two months and Sebelius agreed.

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by: Mike Moran - Monday, November 16, 2009

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A new report shows that, in 2008, Medicare paid more than $17 billion in improper payments for its fee-for-service program, according to an article download Mildred Pierce How to Have an Accident in the Home divx published by The Associated Press over the weekend. When you combine fee-for-service and managed care, that figure rises to $47 billion. That is three times the number of improper payments than the previous year, the AP reported.

Not surprisingly, two of the examples the AP cites as improper payments are related to HME: blood glucose strips for sexual impotence and diabetic shoes for amputees.

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The AP says the Obama administration is expected to announce new initiatives this week to help crack down on Medicare fraud, including "a government-wide Web site aimed at providing a fuller account of healthcare spending and improper payments made by various agencies."

Additionally, CMS will launch "a Web interactive next month that will allow users to track Medicare payment information by categories, such as state, diagnosis and hospital."

Stay tuned...

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by: Mike Moran - Wednesday, November 11, 2009

I spent this morning reviewing a bunch of HME News TV interviews that we shot at Medtrade last month. (We run the video on www.hmenews.com and post a new interview each Wednesday.)

As I watched these interviews (I conducted 30 or so over three days), something struck me. When taken together, they communicate a very optimistic message. These are tough times for HME providers, but the industry has not stopped moving forward, just the opposite.

If you want some insights into how to improve your business, mark these upcoming interviews on your calendar. You can also check out our HME News TV archive, which includes a wealth of information. And it’s all free

– Mike Moran

Here’s the schedule of interviews for the next few months.

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Nov. 11 (today)
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AAHomecare Chairman A.J. Filippis and CEO Tyler Wilson cover a lot of ground in this in-depth interview: industry unity, competitive bidding, healthcare reform, the value of homecare and more.

Nov. 18
Two of the HME’s most prominent advocates, Pride Mobility’s Seth Johnson and Invacare’s Cara Bachenheimer, discuss the industry’s successes and challenges inside the Beltway.

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Nov. 25
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Dec. 2

Don Clayback

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The industry has already made progress toward developing a separate Medicare benefit for complex rehab. Clayback discusses what still needs to be done and how long it might take.

Dec. 9
Denise Fletcher, attorney, Brown & Fortunato

The Recovery Audit Contractors (RAC) intensify Medicare’s efforts to recoup improper payments. Here’s what providers can do to hold onto more of their money.

Dec. 16
Kelly Riley, director. The MED Group’s National Respiratory Network
Grow your sleep business by becoming more active and passionate about promoting public awareness of obstructive sleep apnea

Dec. 23
Frank Margulis, president, Margin Consultants
HME provider Frank Margulis says he made careless mistakes running his business, lost everything and ended up serving five months in jail. He wants other HMEs to learn from his story.

Dec. 30
Sue Chen, president, Nova Ortho-Med
Grow your retail business by helping customers be all they can. Listen to what they have to say, and then match the products that meet their needs.

Jan. 6
Eric Kline, founder, HME SalesPro
Don’t be derailed by all the activity going on in a referral source’s office. Develop a blueprint to keep your sales team on task, focused and successful.

Jan. 13
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Cy Corgan, national sales director for retail mobility, Pride Mobility Products
Provider best practices. Retail mobility makes sense and holds great promise, but HMEs must commit resources to it—time, marketing and staff.

Jan. 20
Don Spence, CEO, Philips Respironics
Philips Electronics acquired Respironics in late 2007. How has that deal impacted Respironics, and what may the impact be going forward—for Respironics and the sleep market?

Jan 27
Sarah Hanna, vice president, ECS Billing & Consulting
It’s never been more important to staff your billing department with qualified people. Here are some thoughts on how to do that.

Feb. 3
Eric Parkhill, vice president, HMP Diagnostics
Here’s how one provider developed a nice new revenue stream by managing sleep labs for hospitals. It’s “fairly easy” to do and doesn’t require billing an insurance company. All you do is invoice the hospital.

by: Mike Moran - Tuesday, November 10, 2009

A friend of mine who works for Maine Public Television recently produced a show on elder abuse

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that really opened my eyes. I’d heard a little about this crime previously, but I had no idea that it occurs nearly as often as child abuse. That’s why it’s referred to as the hidden epidemic: Very few people know about it. Elder abuse is terrible, and what makes it more so is that it's often committed by a so-called loved one, often an adult child.

Because HME providers work so closely with seniors in their homes, it would seem they are in a great position to maybe identify and help stamp out elder abuse. But to do that, you’ve got to know what to be on the look out for, and this show help in that area.

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Remember, this story is based in Maine, but elder abuse is a problem that knows no boundaries

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— Mike Moran

by: Mike Moran - Tuesday, November 3, 2009

Ok. I’ve had it. Given CMS’s problems running Medicare, I was a little bit skeptical (and I still am) of the government’s ability to run a public option program as part of healthcare reform. But now I think the public option is the lesser of two evils. Somebody has to keep the insurance companies honest.

I say that because Aetna, the insurance company we use here at HME News, just informed us that the cost of our healthcare insurance will increase 37% in 2010.

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Let me say that again: 37%. Is that a rip off, or what?

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This got under my skin a little more than it might have because Sears recently charged me a $39 penalty (my payment arrived two days late) on my credit card’s $80 balance. That’s a 49% penalty.

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This is outrageous. What kind of country allows health care premiums to jump 37% a year, and then turns a blind eye as credit card companies stick people with this kind of penalty for such a minor infraction? A country that care's more about special interests than it does about real people, that's what kind.

Before I called Sears to complain, I waited a few days to cool down. When I did call, a pleasant gentleman named Coleman answered and momentarily disarmed me. I told Coleman that I was at fault, and that a penalty was warranted, say $10, but not $39 on an $80 balance. That’s crazy.

Barbie Mariposa and Her Butterfly Fairy Friends film Say no more. Coleman waived the $39 penalty without a fight. In fact, he waved it with such ease that I figured I was not the first to call with this complaint.

Coleman then informed me, in his soft pleasant voice, that my next payment was due in two days and asked if I wanted to pay it by phone.

Sure, I said. Don’t want to risk another late fee. This guy is very polite, I thought.

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Okay. There will be a $14 fee to pay by phone.

I almost choked. Coleman! $14? Forget it.

I’ll wrap this up by saying again that I’ve had it. Bring on the public option, and Coleman, please cancel my Sears credit card.

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by: Mike Moran - Thursday, October 29, 2009

I got a salty phone call this afternoon, full of expletives (lots of F-bombs, which I’ll denote as #@%&) and disbelief/anger over how inept Medicare is at controlling fraud and abuse.

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Here’s the deal. This guy, lets call him Lester, has applied for a Medicare supplier number and is nearly finished with accreditation. Last week, he received a letter from CMS, saying the agency is “happy to welcome me as someone who can bill whatever I want to Medicare. Here’s your supplier number.”

There’s only one problem. CMS is not supposed to issue a supplier number to a new HME unless he is already accredited. That rule took effect March 1, 2008.

Lester called CMS to find out “what’s the #@%& deal.”

“We don’t have our accreditation yet, and there doesn’t seem to be any contingencies here,” he told a CMS official.

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CMS official: “Don’t worry you’ve got a grace period."

Lester: “What's the grace period?”

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CMS official: “I don’t know. I’m not sure.”

What the #@%&, Lester said after hanging up.

“The last thing I want to do is take this #@%& Medicare number and start #@%& using it and get clipped and put in a box for a year," he told me this afternoon. "Here they are handing them out like #@%& crack cocaine on the street corner. How stupid is that? It never fails. It’s amazing to me. They make us look like the bad guys while they are handing out supplier numbers to anybody. It’s #@%& unbelievable.”

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I couldn't say it any better.

Mike Moran

by: Mike Moran - Monday, October 26, 2009

The news magazine “60 Minutes” tackled Medicare fraud and abuse in its lead story last night (“The $60 Billion Fraud”), and reporter Steve Kroft placed the blame squarely where it belongs: on Medicare.

This whole Medicare fraud thing really is a travesty, and CMS doesn’t seem to have a clue how to reduce it. One crook called defrauding Medicare as easy as “taking candy from a baby.” You just send in the claims, he said, and Medicare pays them.

Hang 'Em High dvdrip It’s pretty obvious from this story that CMS does very little to insure that providers are legitimate. Whatever happened to performing a site visit before handing out a provider number?  Many of these crooked providers operate out of dilapidated and abandoned storefronts and in some instance long-term storage facilities with no addresses. These providers are here today and gone tomorrow with millions in taxpayer dollars.

Medicare fraud and abuse is pervasive, Kroft demonstrated, and goes way beyond billing for unnecessary power wheelchairs and other DME. One hospital actually recruited homeless people to fill its beds.

The Medicare and law enforcement officials interviewed for the story hardly inspired confidence. The investigators seemed giddy to be on TV, and when questioned about how to reduce Medicare fraud, Kim Brandt, CMS director of program integrity, had no answers.

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In a particularly pathetic segment, beneficiaries told how Medicare officials ignored (sometimes for years) their reports of fraud and abuse.

Controlling Medicare fraud and abuse is a challenge, no doubt, but trying to do so with a slew of post-payment audits seems like putting the cart before the horse. Any meaningful strategy must start with qualifying providers upfront. You can’t pay claims and ask questions later.

I think health care reform is badly needed, but if CMS doesn't change how it operates, it could end up as just another big payday for the crooks.


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by: Mike Moran - Friday, October 23, 2009

Last year, when provider Edward Eubanks was grappling with national competitive bidding, he didn't share his pain with his patients. This year, it's a different story.

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Eubanks, whose company, Charlotte Respiratory Solutions, is in a bid area, doesn't mean his patients ill will. He just wants them to know what's coming—basically, a program that will make them "second-class citizens." If that concerns them, and he thinks it will, he wants them to share those concerns with their representatives and senators.

Eubanks is also presenting lawmakers with this ultimatum: Sign on to H.R. 3790, a bill to repeal competitive bidding, and we'll let your constituents know you're protecting them; don't sign on and we'll let them know you're not. Eubanks and other providers in the state are working with member services organizations like The VGM Group and NAIMES to develop an advertising campaign that details who is and isn't supporting the bill.

"We've let our representatives and senators know that we're not going to sit idly by this time," Eubanks said. "We're going to unleash a firestorm."

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by: Mike Moran - Thursday, October 22, 2009

This is unbelievable.

For months now Washington lawmakers have been trying to hammer out a reform plan to reduce healthcare costs. So now here comes Sen. Sherrod Brown, D-Ohio, with a bill that would extend Medicare coverage to hearing aids.

Memo to Sherrod: Maybe you haven’t heard, but Medicare is on the road to bankruptcy, and there are a bunch of people inside the Beltway trying to figure out how to avoid that and provide healthcare insurance to millions of our nation’s uninsured. This is not the time to seek Medicare coverage for hearing aids. In fact, it is so not the right time that you seem dangerously out of touch.

In a press release issued today by Brown’s office, there is not one mention of how the senator intends to pay for this expanded benefit.  I also love this line from the press release:

Since the Medicare program was established, hearing aids have not been covered. Instead, seniors are forced to purchase supplemental coverage or pay out-of-pocket for these critical devices A Night at the Roxbury release

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What is this “forced” business? What’s wrong with seniors purchasing supplemental insurance or paying out of pocket? I’m sure there are some who can’t afford to do this, but there are plenty who can.

We don’t want our seniors living in unheated apartments and eating cat food, but we also have to stop treating them like babies. If they’ve got money, let them spend it. Urmel voll in Fahrt rip If it comes down to them having to choose between a hearing aid and two-week vacation on a cruise ship, so be it.

— Mike Moran

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