Archive: April 2017
Prior auth update: No involvement from ATP trips some providers
April 28, 2017Liz Beaulieu, Editor
WASHINGTON - CMS gave insight into how providers are doing with a new prior authorization process for two complex rehab codes during the third in a series of Special Open Door Forums on April 25.During the forum, Dr. Robert Hoover, the chief medical officer for CGS Administrators, the DME MAC for Jurisdictions B and C, cited top non-affirmation reasons for K0856 and K0861 so far. An issue that has popped up in both jurisdictions: no evidence that an ATP had direct, in-person involvement in the selection...
Pacific Pulmonary settles for $11.4M
April 28, 2017Theresa Flaherty, Managing Editor
NOVATO, Calif. - Five years after the FBI raided its offices, Pacific Pulmonary Services has agreed to pay $11.4 million to the federal government to settle allegations that it participated in a kickback scheme.As part of that scheme, in 2006, the company's patient care coordinators allegedly began making patient referrals to sleep testing clinics in exchange for CPAP referrals, in violation of the Anti-Kickback Act.“The allegations are that the company had this wink, wink, nod, nod understanding...
In brief: Data shows sharp decline, Invacare cleared for re-inspection
April 28, 2017HME News Staff
WASHINGTON - Nearly 41% of HME providers have dropped Medicare since July 2013, according to AAHomecare.
That was when Round 2 of the competitive bidding program kicked off in 91 cities with an average reimbursement cut of 45%.
Three states—California, New York and New Jersey—saw declines of more than 60%, while the District of Columbia saw a decline of 85.7%, according to data AAHomecare analyzed from the Medicare Supplier Directory.
Bigger picture, the association found the...
Invacare clear for re-inspection
April 28, 2017HME News Staff
ELYRIA, Ohio - Invacare has completed the final milestones required to lift a consent decree with the U.S. Food and Drug Administration, paving the way for a re-inspection, the company announced April 27.“The re-inspection is an important step before the company may resume full operations at the impacted facilities,” Invacare stated in a press release.The decree has limited Invacare's ability to manufacture and sell certain products from its corporate headquarters and Taylor Street facilities...
Complex rehab stakeholders make their case
April 28, 2017Liz Beaulieu, Editor
ARLINGTON, Va. - The amount of work that needs to get done in Congress this year may be a double-edged sword for complex rehab stakeholders, lobbyists say.
While the chaos could make it difficult for stakeholders to get heard, it could also provide a number of legislative vehicles for their issues, lobbyists told attendees at the National CRT Conference on April 26, after outlining the myriad goals of President Donald Trump and a Republican-controlled Congress, including repealing and replacing...
CMS implements audit improvements
April 28, 2017HME News Staff
WASHINGTON - CMS has announced significant improvements to the processing of serial claims for capped rental items and certain inexpensive and non-routinely purchased items, according to a bulletin from AAHomecare.
It's an issue that has been a challenge for providers for years and contributed to the massive appeals backlog, the association says.
Improvements include:
Instructing the DME MACs to change the process by which they adjudicate appeals of serial claims. Once the reason...
Custom seats, backs return to individual pricing
April 28, 2017Liz Beaulieu, Editor
WASHINGTON - The DME MACs for Jurisdictions B and C have agreed to process all holding claims for custom seats and backs based on individual pricing, Rita Stanley, vice president of government relations for Sunrise Medical, announced at the National CRT Conference on April 26.
Stanley says she was told there are 30 or so such claims for E2609 and E2617.
“As of today, they were going to start processing those claims based on individual consideration again,” she said. “If the...
Fall show on 'track'
April 28, 2017HME News Staff
ATLANTA - Booth sales for Medtrade, which takes place Oct. 23-26 at the Georgia World Conference Center, are on track, show organizers say. Exhibitors such as Tennessee-based ramp manufacturer American Access are returning after a two-year absence, ready to tap into renewed industry optimism, according to a press release. “After the positive vibe from Medtrade Spring and renewed hope for regulatory change in Washington, we are optimistic,” said Kevin Gaffney, group show director, in the...
VGM ready to retail
April 28, 2017HME News Staff
WATERLOO, Iowa - VGM has leased a retail storefront to create a Retail Training Lab at the upcoming Heartland Conference. Located across from the convention center, the 1,100-square-foot showroom will feature healthcare products and display ideas. VGM's online marketing agency, Forbin, will also be in the showroom discussing online marketing tactics and trends to help providers reach their target audience. “We're proud to enhance Heartland Conference attendees' experience by offering...
Brightree buoys ResMed's earnings
April 28, 2017HME News Staff
SAN DIEGO - ResMed reported revenues of $514.2 million for the third quarter of fiscal year 2017, a 13% increase compared to the same period last year. Excluding contributions from Brightree, which ResMed acquired in April 2016, it reported revenues of $479.2 million, a 6% increase. “We had solid double-digit constant currency revenue growth in Q3, led by our Brightree software solutions, as well as mask and device sales," said Mick Farrell, ResMed's CEO. "This quarter we saw strong demand...