In brief: Prior auth burden, VGM Forbin president, JANZ acquisition

WASHINGTON – CMS has finalized a rule that sets requirements for Medicare Advantage organizations and other programs to improve the electronic exchange of health information and prior authorization processes and reduce burden on patients, providers and payers. 

The agency estimates its Interoperability and Prior Authorization Final Rule (CMS-0057-F) will result in $15 billion in estimated savings over 10 years. 

“When a doctor says a patient needs a procedure, it is essential that it happens in a timely manner,” said HHS Secretary Xavier Becerra. “Too many Americans are left in limbo, waiting for approval from their insurance company. Today the Biden-Harris Administration is announcing strong action that will shorten these wait times by streamlining and better digitizing the approval process.” 

Beginning primarily in 2026, impacted payers will be required to send prior authorization decisions within 72 hours for expedited (i.e., urgent) requests and seven calendar days for standard (i.e., non-urgent) requests for medical items and services. For some payers, this new timeframe for standard requests cuts current decision timeframes in half, CMS says. 

The rule also requires all impacted payers to include a specific reason for denying a prior authorization request, which will help facilitate resubmission of the request or an appeal when needed; and publicly report prior authorization metrics. 

Additionally, the rule requires impacted payers to implement a Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) Prior Authorization application programming interface (API), which can be used to facilitate a more efficient electronic prior authorization process between providers and payers by automating the end-to-end prior authorization process. 

The final rule is available to review here. 

The fact sheet for this final rule is available here. 

VGM Forbin names new president 

WATERLOO, Iowa – VGM Forbin, a VGM Group company, has named Cassi Price as its new president.  

Price previously worked at VGM Forbin in 2011, holding multiple roles from web marketing specialist to director of marketing and sales.  

“Cassi brings a deep knowledge and experience in web services,” said Brian Jones, president of group services, who serves as the senior leader of VGM’s marketing agencies, Forbin and Two Rivers Marketing. “With her passion for both serving our customers and leading her teams, she empowers Forbin to continue the exceptional growth and momentum from the last few years. And I am excited for the long-term success she will help bring to Forbin and the customers we serve.” 

Price began her career at VGM in 2007 at the Orthotic and Prosthetic Group of America, a membership community under VGM & Associates. 

Since 2021, Price has served as vice president of corporate projects for VGM. In this role, she oversaw some of VGM’s largest corporate initiatives, including the creation of an on-site childcare center, which opened in November 2023.  

“I am truly honored to have the opportunity to lead such an amazing team,” said Price. “The industries we serve constantly evolve, and each time they do, the Forbin team has been there to meet them. I’m excited to be part of that future and to continue to make a difference for our customers and our community.”  

JANZ diversifies with acquisition of Mullaney’s Medical Supply 

COLUMBUS, Ohio – JANZ Corp., a medical equipment supplier serving military installations and veterans, has diversified into the broader market with its acquisition of Mullaney’s Medical Supply, a locally owned and operated company that has served the Greater Cincinnati area since 1936. 

JANZ, a service-disabled veteran-owned small business, will assume ownership of Mullaney’s Medical Supply locations in Blue Ash, West Chester and White Oak, Ohio, which together provide a wide range of medical equipment for purchase and rental, including oxygen concentrators, mobility aids, lift chairs, beds, mattresses, respiratory equipment, compression items and injury recovery equipment. 

“Mullaney’s Medical Supply has a long history of providing exemplary service to Ohio residents,” said Gordon Pry, COO of JANZ. “We are excited to continue this tradition and look forward to providing medical supply customers with the same high-quality service they have come to expect from Mullaney’s.” 

The new Ohio locations will be known as Mullaney’s, a JANZ Medical Supply Company, and will join the company’s 34 existing medical supply stores located in 11 states, seven countries and two U.S. territories.  

“As a local family business serving the Greater Cincinnati area for more than 88 years, we have a very personal connection to our community,” said Tom Mullaney, RPh, former owner of Mullaney’s Medical Supply and current president of Mullaney’s Long-Term Care Pharmacy. “When we decided to sell our medical supply division, it was clear that JANZ was the perfect partner as they share our commitment to customers and a reputation for exceptional service.” 

In 2017, JANZ ranked No. 280 on the Inc. 5000 list of fastest growing U.S. companies. 

VGM’s Two Rivers Marketing, Moxie merge 

WATERLOO, Iowa—VGM Group merged two of its marketing agencies, Two Rivers Marketing (2RM) and Moxie, effective Jan. 1. The combined team, which will operate as part of Des Moines, Iowa-based 2RM, expands the services and capabilities that each agency has been known for, the companies say. Moxie’s client roster will join 2RM and benefit from a more comprehensive range of services, including channel marketing, public relations and content strategy, brand strategy, and media buying, they say. “Those long-term client relationships are invaluable; we’re committed to a hassle-free shift of Moxie’s clients to 2RM,” said 2RM President Brad Olson. “We have a tremendous amount of business-to-business brain power within 2RM already, and with the addition of so many talented individuals from Moxie I’m excited about what we’ll be able to offer clients, as well as the doors this opens to new business opportunities.” 

Mobius iBOT gets Medicare coverage 

MANCHESTER, N.H. – Mobius Mobility has received Medicare coverage for the iBOT PMD, a multi-modal power wheelchair that allows users to traverse a wide variety of terrain, climb stairs and operate at eye-level. “Team iBOT could not be more excited,” said Lucas Merrow, Mobius Mobility CEO. “Our mission is to deliver the increased mobility and independence that the iBOT PMD provides to anyone who needs it. And affordability is foundational to this effort. With Medicare coverage, iBOT users who are Medicare beneficiaries can finally receive the financial assistance they deserve.” The iBOT PMD has six different operating modes, each providing a different mobility function. For example, in 4-Wheel Mode the iBOT engages all four of its large drive wheels while keeping the seat, and with it the user, level while going up and down slopes. 

VGM Live at Home unveils new website 

WATERLOO, Iowa – VGM Live at Home, a division of VGM & Associates, has launched a redesigned website, www.vgmliveathome.com. Refreshed and enhanced for a more user-friendly experience, the site makes it easier for members to find the information they’re looking for. It also includes a members-only portal with an interactive discussion board, allowing members to engage with each other, receive answers to questions, and openly discuss any challenges, best practices or successes. “At VGM Live at Home, we strive to provide the resources members need to start a home accessibility business or grow an existing one,” said Jim Greatorex, vice president of VGM Live at Home. “We understand the daily business challenges home accessibility providers face, and this new website makes it even easier for members to find the valuable information they need so that they can spend more time on their business and serving their clients’ home accessibility needs.” 

Masimo claims victory 

IRVINE, Calif. – The Federal Circuit has lifted the temporary stay on the import ban of certain Apple Watch models, reinstating the U.S. International Trade Commission’s import ban and cease and desist order on certain Apple Watch models that were found to infringe Masimo’s patented pulse oximetry technology. “The Federal Circuit's decision to lift the temporary stay is a victory for the integrity of the American patent system and the safety of people relying on pulse oximetry,” said Joe Kiani, founder and CEO of Masimo. “It affirms that even the largest and most powerful companies must respect the intellectual rights of American inventors and must deal with the consequences when they are caught infringing others’ patents.” Masimo has previously made available a study showing that Apple Watch’s pulse oximetry missed more than 90% of potentially life-threatening events. The Apple Watch pulse oximeter was not cleared by the U.S. Food and Drug Administration for medical use. The Masimo W1 health watch was recently cleared by the FDA for its indicated medical uses, including continuous pulse oximetry. 

DoctorNow, Venture Medical partner to streamline services 

BELLEVUE, Wash. – DoctorNow and Venture Medical have entered into a national agreement to support wound care providers and improve patient outcomes by streamlining electronic healthcare records processes while also improving the efficiency of the supply chain of cutting-edge wound products. By combining Venture Medical's wound-care solutions and regenerative therapies with DoctorNow's Post-Acute Wound Electronic Health Records solution, providers will have increased visibility, simplicity and tracking, which will bring cost savings, process improvements and, ultimately, improved patient outcomes, the companies say. "We are very excited to partner with Venture Medical to bridge the gap between providers working with patients, electronic health records, products and services to improve patient outcomes,” said Dr. Kashif Saeed, CEO and founder of DoctorNow. “This is the first step in a strategic partnership to push the boundaries of what is possible for wound care.” 

Biofourmis launches in-home solution 

BOSTON – Biofourmis, a global technology-enabled care delivery company, has launched its in-home services solution. From within the Biofourmis platform, providers can now order, schedule, confirm and track a comprehensive range of in-home services and diagnostics such as nursing, phlebotomy, infusion, durable medical equipment and imaging — on-demand. The first-in-market functionality supports Biofourmis Care solutions, as well as digital clinical trials solution Biofourmis Connect. The platform provides: integrated workflows for more efficient operations; Biofourmis-managed services for less program overhead; a la carte models to fit each customer's needs; and a focus on continuity of care for improved patient experience. "The idea for this innovative in-home services ecosystem came from listening to our health care and biopharma clients, who told us they could more easily launch and scale their care-at-home and digital clinical programs if they had on-demand access to in-home services from a curated network of trusted providers," said Dr. Maulik Majmudar, chief medical officer and co-founder of Biofourmis. "With flexibility and scalability in mind, our customers can access Biofourmis-vetted service providers, or they can take a hybrid approach in which they onboard some of their own local service providers where they already have existing networks. We will continue to curate and validate our ecosystem based on market need and feedback." 

United Spinal relaunches etiquette guide 

KEW GARDENS, N.Y. – United Spinal Association has relaunched its popular Disability Etiquette Guide, which was initially published soon after the American Disabilities Act was passed in 1990. The guide seeks to educate businesses, schools and the general public about the disability community and contains helpful statistics and language guidelines. “Our original Disability Etiquette Guide had an enormous impact for members of the disability community in workplaces, schools, and fellow membership and volunteer organizations across the nation,” said United Spinal President and CEO Vincenzo Piscopo. “I am so pleased to launch a new version that is more than equipped to continue this work in a new era — for a new, digital generation.” Brand-new features of the guide include up-to-date data about the composition of the disability community and accessibility guidance for the web. It also overhauls the guidance about culturally competent terminology and behavior, making it more reflective of the lived experience of today. The rebooted guide can be found here, where it is supplemented with public service announcements that have aired on live television and an abridged Top 10. 

Iowa House reintroduces CRT bill 

DES MOINES, Iowa – State Rep. Brian Best has introduced House File 562, a bill related to insurance coverage for the maintenance and repair of complex rehabilitation technology wheelchairs, according to a MAMES bulletin. Among other things the bill would: provide all definitions such as “complex rehabilitation technology wheelchair,” “qualified complex rehabilitation technology wheelchair supplier” or “qualified supplier” and “qualified complex rehabilitation technology professional”; provide information on service and repair; and, beginning Jan. 1, 2024, require a supplier to provide service and repairs on the wheelchair as requested, except in the circumstances detailed in the bill. The bill also prohibits a third-party payer, as defined, from requiring prior authorization or documentation of continued medical necessity from the supplier to provide service and repairs. Additionally, the bill provides details on a task force that would include CRT suppliers and professionals and that would determine reimbursement rates. MAMES had an opportunity to provide feedback on the legislation prior to it being introduced and will be working through the MAMES IA Insurance Committee to monitor the legislation.  

EZ Mobility opens new office in Roanoke 

ROANOKE, Va. – EZ Mobility Solutions has moved into its newly opened office and showroom at 4549 Shenandoah Avenue NW in Roanoke, Va. The new building is about 33,000 square feet with an 8,000-square-foot training area for the team. The space also includes a community area for local disability groups. “To go from a space in my garage to this space in just 10 years seems surreal,” says David Todd, president. “We have had some luck and a ton of hard work to get here, and this is a huge accomplishment.” One highlight of the move is the company’s new proximity to the Salem Veterans Affairs Medical Center. EZ Mobility Solutions will hold an official opening ceremony for the new space in the spring.