Archive: May 2004
Greed, laziness likely fueled crooked sales rep
May 31, 2004HME News Staff
NORFOLK, Va. - A former sales rep for Home Care Supply, the nation's largest independent HME, could be going to jail for forging physician signatures on CMNs and fraudulently billing insurers for roughly $460,000.
Between May 1999 and January 2003, Amy E. Gowin lied on medical documents by indicating that patients needed equipment or medication that their doctors had not prescribed, court records show. She provided false test results and medical conditions and forged the signatures of 54 physicians...
Stratifying service levels raises an ethical question
May 31, 2004HME News Staff
Although Medicare does not require its Part B contractors to provide home delivery for beneficiaries, it has long been customary for them to do so at no charge.
But under the margin-erasing provisions put forth in the Medicare Prescription Drug Act that practice may come to a grinding halt. In fact, homecare consultant Kevin O'Donnell recommends providers get out of the transportation business altogether. Instead of shouldering the costs of fleet management, providers could instead arrange for third-party...
CMS expands provider e-mail service
May 31, 2004HME News Staff
June 1, 2004
WASHINGTON - CMS has expanded the Medicare information that is available immediately to health care providers via electronic mail, thereby helping providers give beneficiaries the highest quality care, CMS Administrator Mark McClellan announced last week.
CMS has now completed a series of listservs for Medicare providers. The newest listservs are for durable medical equipment suppliers, acute inpatient hospitals and inpatient psychiatric facilities.
CMS had previously established...
Transitions
May 31, 2004HME News Staff
Providers
Crystal Lore has been appointed president of Simplex Medical, a national provider of diabetes testing and respiratory supplies located in Fort Myers, Fla. Lore's most recent experience includes serving seven years as senior vice president of new business development at Liberty Medical. She takes the position previously held by Federick Roberts, who also serves as the company's CEO.
Vendors
Winston Anderson, of Merits Health Products in Coral Coral, Fla., has taken a leave of absence from...
Industry advocates: The time is right to rethink the ABN option
May 31, 2004HME News Staff
The Advanced Beneficiary Notice - intended to be a lever for Medicare equipment upgrades - hasn't really caught on with providers since its inception a couple years ago. But with the Medicare Prescription Drug Act promising to seal off conventional revenue paths, it may be a good idea for providers to give the ABN another look, industry advocates say.
Dave Williams
In describing their reticence to use ABNs, providers say the main obstacles have been the fear of triggering an audit, complicated billing...
Briefs
May 31, 2004HME News Staff
Accreditation board created for compounding
WASHINGTON - A coalition of professional and regulatory pharmacy organizations announced in April the creation of a voluntary accreditation program for pharmacy compounding. The Pharmacy Compounding Accreditation Board (PCAB) was established to help improve the quality of compounding. An initial focus of the program is to develop standards of practice and to accredit pharmacy sites engaged in compounding at a designated level of complexity. The process...
Industry awaits DME standards committee
May 31, 2004HME News Staff
WASHINGTON - Look for an advisory committee to help CMS develop quality standards for DME to be assembled later this year, possibly by late summer.
Following development of the standards, CMS will incorporate them into a mandatory accreditation program for DME. Members of the standards committee could include providers and beneficiaries and other stakeholders in the Medicare program, say industry watchers.
“We have given them the association's name as a resource, and they have indicated that...
NYMEP turns up the heat
May 31, 2004HME News Staff
ALBANY, N.Y. - The New York Medical Equipment Providers Association in April hired its first full-time staff member, Executive Director Matthew Guilbault.
“We chose to move into a staff model because we felt with all the things coming down the pike and all that is happening as far as cuts in reimbursement that a lot of the issues needed a little more attention,” said NYMEP President Gloria Murray. “We wanted someone to be working for us on a constant basis all week long.”
Negri...
Billing
May 31, 2004HME News Staff
Dealing with a probe review
With Peggy Walker
Q. What is a probe review?
A. A probe (prepay) review is when a specific HCPCS code or group of codes is going to be stopped and looked at by the Medical Review team before it pays.
What happens than?
The claim is “developed” which means a letter is sent to the provider requesting specific information. Of course, the letter would be specific to the item being reviewed but usually includes:
- A copy of the order for the item.
- A delivery...
D.C. pols unveil COPD Caucus
May 31, 2004HME News Staff
WASHINGTON - The congressional spotlight on COPD and home oxygen therapy brightened considerably in April when Sen. Michael Crapo, R-Idaho, announced the formation of a COPD Caucus.
The caucus has dedicated itself to educating Americans about COPD and promoting policies that improve the lives of COPD patients. Sen. Blanch Lincoln, D-Ark., Rep. John Lewis, D-Ga., and Rep. Cliff Stearns, R-Fla., will join Crapo as co-chairs.
COPD is the fourth leading killer disease in the United States, claiming...