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by: Mike Moran - Thursday, February 7, 2008

Back in 2006, CMS thought it would be a good idea to compare Medicare and Internet pricing for power wheelchairs to help create new fee schedule amounts. After an uproar from the industry, however, the agency relented.

More recently, in October 2007, the Office of Inspector General (OIG) also compared Medicare and Internet pricing for power wheelchairs. Lo and behold, it found that Medicare prices were 45% higher, on average, than median Internet prices for 28 codes. Again, the industry fought back, arguing that, unlike Internet retailers, Medicare providers must adhere to numerous standards and provide numerous services.

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Rep. Pete Stark, D-Calif., gave new life to the comparison in November 2007, citing the OIG's report in a "Dear Colleague" letter.

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It's an idea that won't go away, and it may get worse. In a recent meeting with AAHomecare and NCART, the OIG indicated that it plans to audit claims this year to calculate service-related costs for both standard and complex power wheelchairs. It sounds like the OIG wants to know if there's any beef to the industry's service cattle call.

According to an AAHomecare update on Wednesday: "AAHomecare is extremely concerned that the OIG’s upcoming efforts will not accurately quantify the full costs of providing power wheelchairs because the HCPCS coding system does not require the collection of this data. Government studies that suggest that limited services are being provided to Medicare beneficiaries who are furnished power wheelchairs could lead to another round of reimbursement cuts for power wheelchair payments."

Rightly so, AAHomecare and NCART plan to come up with their own numbers. They announced last week that they plan to develop a framework to calculate the service and overhead costs of providing a full range of power wheelchairs to Medicare beneficiaries. They also plan to develop a template that would allow providers to document their time with patients.

If you know what's good for you, you'll make it a priority to help them out.

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by: Mike Moran - Wednesday, January 23, 2008

Michael Watson has some real concerns about CMS's proposal to change the Medicare appeals process, and the industry should feel the same way, he says. Unfortunately, because CMS published the proposal in the Federal Register Dec. 28—during a time when may people are on vacation—most providers don't know about this proposal, said the vice president-governmental affairs for American Medical Technologies.

The Long Riders psp In a nutshell, the proposal—to the detriment of providers—would give CMS much more control over the process. Providers have until Jan. 28 to submit public comment on the proposal, and Watson encourages them to do so ASAP. Their livelihood could depend on it, he said.

In an email to HME News, here's what Watson had to say about the proposal:

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First, the primary problem this proposal presents is the “published guidance” issue. If allowed to become effective, any functionary (or Medical Director) from ANY Medicare Contractor can publish a directive, coverage guideline, etc. to the contractor’s web site and it, under the definition listed in the proposal, becomes “published guidance” and must be followed by both the ALJs AND the DAB. There is no room for interpretation here.

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We have seen time after time where a Medical Director publishes a “coverage guideline” that is contrary to the way things have previously been done (and sometimes contrary to all logic). Under this proposal, those epiphanies become “published guidance” which ALJs and the DAB must follow (not interpret) when rendering their decisions. Consider glucose test strips, if Dr. Hughes decided that two per day were enough and published this opinion either on the web site or in a “broadcast” e-mail, it would then become “published guidance” under the new rules. It would immediately evolve from a “guideline” to a “hard-and-fast” rule. As such, it would eliminate any possibility of individual patient consideration and no one, under any circumstances would be able to receive Medicare reimbursement for more than two per day. Since CMS seems to move at the rate of maple syrup in Maine in December, getting these “published guidance” articles revoked could be a long and expensive process for providers. In the meantime, claims remain unpaid.

This, as you can imagine, represents a very, very slippery slope down which CMS and their contractors will be pushing providers.

As to the effect on ALJ decisions, the Proposed Rule states, “Because Board (DAB) review is not a mandatory part of the appeals process . . .[the Board can decline review of an ALJ decision], we are proposing Secretarial review of both ALJ decisions that the Board has declined to review and Board decisions.” What this means is that ANY ALJ decision with which the Secretary (or his/her designee) disagrees and is unable to convince the DAB to review, would be subject to the Secretary’s (or his/her designees’) review and reversal. The only oversight available to the provider/supplier or beneficiary will then be relief through Judicial Review (the Federal Court System).

The time for comment on this Proposed Rule is short, it expires close of business 1/28/2008, so the provider/supplier community needs to act and act together.

* * * * * * * * * * * * * *
Michael D. Watson
Vice President - Governmental Affairs
American Medical Technologies
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Email: michaelwatson207@sbcglobal.net

by: Mike Moran - Monday, January 21, 2008
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The VGM Group sent a letter to AAHomecare last week, urging the association to remove the Scooter Store from its Rehab and Assistive Technology Council (RATC).

"All of us here (at VGM) can see that the Scooter Store has a different agenda than the rest of the industry," said Jerry Keiderling, president of VGM's US Rehab. "The industry needs to stand together. Multiple voices and agendas on the Hill don't work."

VGM's concern revolves around a letter the Scooter Store sent to some congressional offices in December. That letter appeared to support competitive bidding, although Scooter Store CEO Doug Harrison has since said that is not exactly the case.

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Here is the letter VGM sent to AAhomecare:

Tuesday, January 15, 2008

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To: AAHomecare RATC Executive Committee
Tim Pederson, RATC Chair
Seth Johnson, RATC Vice Chair
Michael Reinemer, AAH VP Communications & Policy

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As a supporting member of AAHomecare and an active participant with the Rehab and Assistive Technology Council (RATC), I feel it imperative to voice my concerns on a certain matter relating to our rehab industry as a whole.

I’m sure that you have seen the announcement by HME News of the letter writing campaign to members of Congress being conducted by The Scooter Store organization. Their message is clear and concise. Their intent is to actively and aggressively promote Competitive Bidding nationwide and include both consumer power products along with complex rehab in the bid categories. This stance clearly conflicts with the efforts of the RATC and all other industry organizations in our efforts to exempt rehab from the bidding process.

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I find it difficult to believe that having representatives of The Scooter Store within the RATC can have anything other than a negative effect on our efforts to support the industry. I would therefore ask you to reconsider the involvement of The Scooter Store representatives on this council. We need one voice carrying a single and positive message to Capital Hill. Our opposing agendas will only result in fragmented and divided efforts, leaving policy makers with a dull view of our intent.

I have attached copies of both the HME News article and a copy of a letter written by Mr. Mark Leita of The Scooter Store directed to members of Congress. Please take this under serious consideration.

I will await your reply.

Sincerely,

Jerry Keiderling
President
U.S. Rehab

by: Mike Moran - Thursday, January 17, 2008

No sooner does the industry escape Medicare reimbursement cuts to oxygen and power wheelchairs, than more cuts are back on the table.

AAHomecare reported Wednesday that: “Senior staff from two key congressional committees confirmed at a conference in Washington today that oxygen therapy and durable medical equipment items and services are at the top of the list for Medicare reimbursement cuts this year.”

This revelation coincides with news reports that “the budget President Bush will release next month might include a proposal to fix a scheduled Medicare physician fee cut.”

A 10.6% cut to Medicare physician reimbursement is scheduled to occur July 1. Lawmakers will look to avoid that by cutting other benefits, including HME. As you recall, they considered doing that in December but bought themselves more time by delaying the doctor cuts six months.

If you haven’t participated in industry efforts to educate lawmakers to cost-effective patient-preferred nature of home care, now would be a good time to start.

by: Mike Moran - Friday, January 11, 2008

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Revelation hd Check out this story that ran today in the Pittsburgh Post-Gazette. It does a nice job of presenting the impact national competitive bidding will likely have on independent home medical equipment providers. When you consider the hatchet jobs the industry has endured recently (NYT and NPR

, for example), it’s nice to see a reporter take the time to present the industry’s point of view.

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Providers all over the country should read this and use it as a template to pitch similar stories to their local news sources.

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by: Mike Moran - Tuesday, January 8, 2008

CMS released its annual report on health care spending today. There's no mention of HME but, according to the actuaries, home health care continues to be the fastest growing component of all personal health care spending, 9.9% annually in 2006. That's down, thanks to reimbursement cuts, from 12.3% in 2005.

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They're Off psp Titanic download Hospital spending, by the way, accounts for 31% of total healthcare spending in the United States and grew by 7% in 2006. That's down from 8.2% growth in 2002. And what do you think has slowed the growth? In part, "lower utilization of hospital services, especially within Medicare as fee-for-service inpatient hospital admissions declined."

At some point, you hope more bureaucrats and lawmakers in Washington get it: Homecare is key to slowing the overall cost of healthcare in this country. These numbers say as much.

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These and other findings can be found in a report by CMS’ Office of the Actuary, released today in the health policy journal Health Affairs.

by: Mike Moran - Tuesday, January 8, 2008

Want to find out if your company's located in one of the 70 metropolitan statistical areas (MSA) where CMS plans to expand competitive bidding in 2009? If you do, click here. Mysterious Mr. Moto rip

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by: Mike Moran - Monday, January 7, 2008

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It doesn't look like the industry is any closer to answering this question: Does a CMN, in and of itself, establish medical necessity?

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The U.S. Court of Appeals for the Ninth Circuit sided with CMS Dec. 21, saying the agency has the right to require documentation beyond CMNs for power wheelchairs ( Click here to download to the decision). It's the latest chapter in Maximum Comfort’s attempts to prove that CMS wrongly demanded it repay about $600,000 for failing to supply documentation beyond CMNs to establish medical necessity for certain claims.

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Since the late 1990s, the case has worked its way through the judicial system: Cigna’s in-house administrative process (Maximum Comfort lost), two administrative law judges (won), the Medicare Appeals Council (lost) and the U.S. District Court for the Eastern District of California (won). CMS appealed the district court decision, sending the case to the Ninth Circuit.

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In its opinion, the Ninth Circuit referred to the Medicare Act subsection on CMNs, stating, “The subsection does not state that the certificate of medical necessity is the sole vehicle for claims reimbursement, nor does it state that a completed certificate established, by itself, a right to reimbursement.”

With the score even, at 2-2, CMS and Maximum Comfort have one more round to go: the U.S. Supreme Court.

by: Mike Moran - Thursday, January 3, 2008

Before 2007 becomes a faint memory, here are the 10 most viewed HME News stories for the year. It’s no surprise that fraud is the subject of four of the top 10 stories, national competitive bidding is the subject of three stories and industry legislation is the subject of two. Wrapping up the year is a late-breaking story about CMS’s decision to open the doors to home-based sleep tests. Do you think the same issues will lead our coverage in 2008? Time will tell…

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1. Competitive bidding: Industry message falls on 'sympathetic ears' (2,266 views)

2. Bidding bungle: If you're not participating, 'how are you going to stay alive?' (2,064)

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3. New York Times story savages HME industry (1,896)

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4. NPR takes second look at DME fraud (1,675)

5. Competitive bidding: CMS gives few details during 'frustrating' meeting (1,668)

6. Industry continues push to keep HME provisions off the table (1,538)

7. Industry legislation gets fresh blood (1,354)

8. OIG lays out year's worth of DME investigations (1,246)

9. 'It's time to take the gloves off' about fraud (1,243)

10. At-home sleep testing could be on its way (1,203) Transporter 2 release

by: Mike Moran - Friday, December 28, 2007

Knock Off buy There are a bunch of people in Phoenix singing the praises of the John C. Lincoln Better Breathers support group and with good reason. For the past few years, the hospital has used “harmonica therapy” to help COPD patients breath better.

Mike Clark, a registered respiratory therapist at the hospital, leads the monthly group meeting. He teaches newcomers how to play the instruments and compliments the smooth, steady, sustained notes.

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Garden State movies "Everybody in here has lung disease," Clark explained. "Playing the harmonica strengthens the major muscles used in breathing. Anyone can play the harmonica."

Harmonica therapy has been available at John C. Lincoln for a few years. Before that, patients exercised their lungs by blowing out candles or walking on treadmills.

This story ran in The Arizona Republic. Click here King Kong release to read it.

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