Archive: February 2013
Review finds 80% error rate for power wheelchairs
February 28, 2013HME News Staff
WASHINGTON - A prepayment review of power wheelchair claims processed in Jurisdiction B resulted in an 80% error rate, according to National Government Services (NSG), the DME MAC there. Of 1,022 claims processed from Oct. 1 2012�-Dec. 31, 2012, 122 were paid in full, while the remaining claims were completely or partially denied, according to the review. The most common reasons for denials were: Local Coverage Determination (LCD) criteria not met; face-to-face examination with a physician not...
Competitive bidding: Judge rebukes CMS
February 28, 2013HME News Staff
MINNEAPOLIS - A federal judge may have granted the government's request to dismiss a competitive bidding-related lawsuit filed against CMS by a specialty HME provider, but that doesn't mean he thinks justice was served.
“This is a sad day for those who believe that when a judge adheres, even-handedly, to his or her oath of office, justice will prevail and the public interest will be served,” U.S. District Judge Donovan Frank wrote in a memorandum.
Shoreview, Minn.-based...
Review finds 85.6% error rate for intermittent caths
February 28, 2013HME News Staff
WASHINGTON - A prepayment review of intermittent catheterization kits processed in Jurisdiction B resulted in an 85.6% error rate, according to National Government Services (NGS), the DME MAC there. Of 257 claims processed from Sept. 1-Dec. 31, 2012, 220 were denied, according to the review. The most frequent denial—“failure to meet one or more of the required coverage criteria”—accounted for 37% of denied claims. Sixty-one of the claims were denied because the requested documentation...
Sleep960, C-PAP Horizon team up
February 27, 2013HME News Staff
FORT MYERS, Fla. - Signature Sleep Services (d/b/a Sleep 960) and C-PAP Horizon Project have agreed to integrate their sleep products and services, and combine their marketing efforts, according to a press release. Sleep960 provides diagnostic and therapy products, consultation and management services, and PSG educational courses. C-PAP Horizon provides technology and business services for HME providers who specialize in sleep therapy. Previously, some products did not share data and were not designed...
Scooter Store CEO: 'We respect' investigation
February 27, 2013HME News Staff
NEW BRAUNFELS, Texas - A week after federal and state agencies raided its headquarters, The Scooter Store released a statement saying it is complying with the investigation.“We respect the government's investigation and will continue to work with investigators to make sure they have access to the information they need to conclude their activities,” stated Marty Landon, CEO of The Scooter Store.Neither The Scooter Store nor the FBI has stated the reason for the investigation. When asked...
Reps 'concerned' about rates for diabetes testing supplies
February 27, 2013HME News Staff
WASHINGTON - A pair of lawmakers have asked the Government Accountability Office (GAO) to study the impact of a 72% cut, on average, to reimbursement set to go into effect July 1 as part of a national mail order program for diabetes supplies. In a letter, Reps. Diana DeGette, D-Colo., and Ed Whitfield, R-Ky., co-chairs of the Congressional Diabetes Caucus, stated they are “concerned about what it will mean for beneficiaries' access to diabetes testing supplies (DTS) and their ability to...
Event spotlight: Structure and response
February 26, 2013Theresa Flaherty, Managing Editor
One of the basic concepts of getting reimbursed is that it's not a single act, but a series of processes that proceed in a logical order, says consultant David Franklin. “If you screw up any one step along the way, you negate the final outcome,” said Franklin, president of Advanced Care Consulting Services.To that end, Franklin has put together a nuts-and-bolts look at the reimbursement process for the National Home Infusion Association's (NHIA) Reimbursement Pre-Conference on April...
The team is the theme at conference
February 26, 2013Theresa Flaherty, Managing Editor
DALLAS - For more than 20 years, the home infusion industry has worked to get a comprehensive Medicare benefit for home infusion therapy—a tall task, says the National Home Infusion Association (NHIA).So to invigorate these ongoing efforts, the association has themed this year's annual conference and exposition “Fortifying Our Future.”“We have a new Congress to get in front of, and we have some new efforts underway to collect data and to help providers tell our story and keep...
Business operations: Get perspective on valuation
February 26, 2013Jennifer Keirn
There's often a wide gap between what an HME provider thinks his business is worth and what an investor will actually pay, according to Craig Hittle of Somerset CPAs. At Medtrade Spring, Hittle will offer some perspective on what your company might be worth, and how to strengthen it for maximum valuation.
HME News: What are the factors most impacting valuations right now?
Craig Hittle: In this particular industry, valuations are built on future cash flows of the business. In the current...
Former HME providers plead guilty to Medicare fraud
February 26, 2013HME News Staff
WASHINGTON - Two former owners of a Los Angeles-area HME wholesale company pleaded guilty to conspiring with their customers to defraud Medicare, according to a press release from the Department of Justice. Rajinder Singh Paul and Baljit Kaur Paul, the former owners of Major's Wholesale Medical Supply based in Redlands, Calif., entered guilty pleas in the Central District of California Court to one count of conspiracy to commit healthcare fraud. According to court documents, the Pauls sold power...