Archive: May 2014
Stakeholders say prior auths need to be timely, efficient
May 30, 2014Theresa Flaherty, Managing Editor
WASHINGTON - Although industry stakeholders are still combing through a plan to implement a prior authorization (PA) process for certain DME, they think it could be a good thing—with a few caveats.PAs can provide assurance that the criteria for medical necessity have been met and that the claim will likely stand up under an audits. Both mean the provider is more likely to get paid.“I think folks generally support it, but it's got to be done on a timely basis and it's got to be efficient,”...
Managed care monopoly?
May 30, 2014Liz Beaulieu, Editor
ORLANDO, Fla. - Industry stakeholders are taking issue with Univita Health's role as both a third-party administrator (TPA) and HME provider in Florida's transition to managed care for Medicaid.
Univita has been chosen as the network administrator for 10 of the 14 plans participating in the program, representing roughly 84% of impacted Medicaid recipients. That means it decides which providers are allowed into its network and which get referrals, according to Deanna Rollyson, president...
DME MACs update face-to-face guidelines
May 30, 2014HME News Staff
WASHINGTON - The DME MACs on May 29 revised a bulletin on the face-to-face requirement to add information clarifying who may perform the in-person visit and the responsibilities of the ordering physician. The face-to-face exam must be performed by a physician (MD, DO or DPM), physician assistant (PA), nurse practitioner (NP) or clinical nurse specialist (CNS) within six months of the written order for certain DME. The responsibilities of the ordering physician include: documenting that the beneficiary...
Permobil buys TiLite in bid to become 'solutions company'
May 30, 2014Liz Beaulieu, Editor
LEBANON, Tenn. - Permobil has acquired Pasco, Wash.-based TiLite in a move that the two companies believe creates a “dream team” in the complex rehab market.
“It's the best of power and manual,” said David Boninger, vice president of communications for TiLite.
The two companies, which have combined sales of about SEK 2 billion, will continue to operate and brand their products independently, company officials say.
With the deal, Permobil takes another step toward...
Booth space at Medtrade going fast
May 30, 2014HME News Staff
ATLANTA - Medtrade has already booked most of its booth space for the Oct. 20-23 event in Atlanta, according to show organizers. As of May 29, 93% of space has been booked, and show organizers say they expect the remaining 7% to be sold in the coming months. In other news, show sponsor Emerald Expositions has teamed up with CloserStill Media and LiveMed to provide Medtrade exhibitors with an opportunity to reach new international markets through two new events: Trade Days in Birmingham, England,...
Brightree, McKesson streamline ordering
May 30, 2014HME News Staff
ATLANTA - As part of a new integrated electronic purchasing program with McKesson, Brightree users can now view item item availability in real time; perform one-touch drop shipments; and receive automatic confirmations, including delivery notifications. “This enhanced strategic relationship for Integrated ePurchasing will continue to provide common customers significant time and cost savings that come with real-time integration,” stated Jeff Bowman, vice president of homecare sales for...
In brief: PMD spending down, F&P earnings up
May 30, 2014HME News Staff
WASHINGTON - Spending on power mobility devices (PMDs) continues to fall nationwide since the September 2012 launch of a demo requiring prior authorizations in seven states, CMS says. Monthly expenditures for PMD codes dropped from $12 million in September 2012 to $3 million in December 2013 in demo states, and from $20 million to $6 million in non-demo states across the same time period, according to an update. “While we recognize that multiple factors contributed to the decrease in...
New proposal digs deeper into wheelchair codes
May 30, 2014Leah Hoenen
WASHINGTON - Certain wheelchair codes not included in the current PMD demo project could be included in a new prior authorization program recently proposed by CMS.
Included in a “master list” of codes that could be included in the program are K4 lightweight manual wheelchairs and Group 3 power wheelchairs with power options. The PMD demo includes Group 3 power wheelchairs, but only those without power options, says Martin Szmal, founder of The Mobility Consultants.
The list includes...
DME MAC releases oxygen, CPAP review data
May 29, 2014HME News Staff
HINGHAM, Mass. - NHIC found a 44% denial rate for oxygen and oxygen equipment as part of a review of claims filed between Jan. 1, 2014, and March 31, 2014. The Jurisdiction A DME MAC reports responses to additional documentation requests were not received for 59% of the claims. For the same time period, the NHIC found a 64.3% denial rate for CPAP devices. Oxygen claims were most frequently denied for missing documentation; failing to meet written order prior to delivery requirements; and failing...
When will the M&A market for HME level off?
May 29, 2014Liz Beaulieu, Editor
Here's a sneak peek at The Braff Group Insider for the June issue. (Also, I want to apologize for misspelling peek in my last sneak peek...I hate it when I do that.) This graph breaks down transaction trends for the HME industry from 2009 through the first quarter of 2014. See a pattern?
TBG Insider.png
Commentary from The Braff Group:
Based...