In brief: Wheelchair bill, RPM monitoring, catheter billing

WASHINGTON – Sens. Marsha Blackburn, R-Tenn., and Tammy Duckworth, D-Ill., have introduced legislation that would improve access to titanium and carbon fiber manual wheelchairs for Medicare beneficiaries. 

S. 5154, which would create two new HCPCS codes for complex rehab technology manual wheelchairs and would allow for upgrades, is a companion bill to H.R. 5371. 

“The Senate bill drops at an opportune time for mobility stakeholders and disability advocates to ask their legislators to co-sponsor and move the bill forward, coming on the heels of AAHomecare’s Sept. 10 CRT-focused Capitol Hill fly-in and NCART and (U.S. Rehab’s) fly-in Sept. 24,” the association stated in a bulletin. 

Currently, if a consumer wants a titanium or carbon fiber manual wheelchair, they must pay for the full cost out of pocket, have their provider file a non-assigned claim on their behalf, and, if approved, wait to receive 80% of the Medicare allowable. 

AAHomecare, NCART and U.S. Rehab are asking stakeholders to reach out to their senators to ask them to co-sponsor and support S. 5154, as well as reach out to their representatives in the House to co-sponsor H.R. 5371. 

“U.S. Rehab has been actively engaged in Washington, D.C., over the past few weeks, collaborating closely with NCART and AAHomecare,” said Tyler Mahncke, president of U.S. Rehab. “Our efforts have focused on educating policymakers about the health benefits and consumer choice associated with upgrading to carbon or titanium base manual chairs. As a budget-neutral measure that offers significant benefits to consumers, this initiative represents a positive step forward.”   

Find additional guidance on messaging and reaching out to Capitol Hill at https://aahomecare.org/CRT-Advocacy and https://www.vgm.com/services/government-relations/action-center/. 

OIG: More oversight needed of remote patient monitoring 

WASHINGTON – CMS needs to provide more oversight of remote patient monitoring to ensure it is being used and billed properly, says a new report from the Office of Inspector General. 

From 2019 to 2022, use of remote patient monitoring increased dramatically, from about 55,000 enrollees to 570,000. In 2022, payments for these services by traditional Medicare and Medicare Advantage were more than $300 million, compared to just $15 million in 2019. 

However, the OIG found 43% of Medicare beneficiaries who received remote patient monitoring did not receive all three components of the service: education and setup, device supply and treatment management. Medicare pays for all three components separately and pays the same rate, regardless of the type of device used or data collected. 

The OIG recommends that CMS take the following steps to strengthen oversight of remote patient monitoring:  

• Implement additional safeguards to ensure that remote patient monitoring is used and billed appropriately in Medicare 

• Require that remote patient monitoring be ordered and that information about the ordering provider be included on claims and encounter data for remote patient monitoring 

• Develop methods to identify what health data are being monitored  

• Conduct provider education about billing of remote patient monitoring 

• And identify and monitor companies that bill for remote patient monitoring. 

CMS concurred with or stated that it would take into consideration all the OIG’s recommendations. 

Read the full report here. 

CMS issues final rule on catheter billing 

WASHINGTON – CMS has issued a final rule that addresses suspicious billing activity within the Medicare Shared Savings Program that resulted in an increase in DMEPOS billing for certain intermittent urinary catheter supplies. The rule, “Medicare Program: Mitigating the Impact of Significant, Anomalous, and Highly Suspect Billing Activity on Medicare Shared Savings Program Financial Calculations in Calendar Year 2023” (CMS-1799-F) is part of a larger strategy to address significant, anomalous and highly suspect (SAHS) billing activity within Accountable Care Organizations (ACOs) reconciliation. This rule finalizes changes in policies for assessing performance year (PY) 2023 financial performance of Shared Savings Program ACOs; establishes benchmarks for ACOs starting agreement periods in 2024, 2025, and 2026; and calculates factors used in the application cycle for ACOs applying to enter a new agreement period beginning on Jan. 1, 2025, and continuing their participation in the program for PY 2025, as a result of SAHS billing activity for the two intermittent urinary catheter codes. A proposal in the calendar year (CY) 2025 Physician Fee Schedule (PFS) proposed rule addresses SAHS billing activity for CY 2024 onward. In early 2023, CMS identified a concerning rise in urinary catheter billings attributed to a small group of DME companies. The agency determined that the beneficiaries did not receive catheters and were not billed directly, physicians did not order these supplies and supplies were not needed. The observed billing was for A4352 and A4353. CMS issued the proposed rule June 28. 

• Go here for more information on the final rule. 

Former AdaptHealth exec takes reins at Advantage Healthcare 

CHERRY HILL, N.J. – Advantage Healthcare, a patient-centered health care provider that manages and operates comprehensive outpatient rehabilitation facilities and sleep centers, has named Dinak (Dino) Nair as its CEO, succeeding Ryan Tong. Nair brings more than 20 years of business experience, with more than a decade as a mission-driven leader growing businesses in the health care market, especially in home care, home medical equipment, diagnostic laboratory, and health system partnerships. “I am excited to join the Advantage family, and lead the company in our continued growth, building on the positive energy that has been established,” said Nair. “I look forward to collaborating closely with our team to execute initiatives to drive improved patient outcomes through greater access, while delivering value to our customers and stakeholders.” Nair most recently served as vice president and general manager of the Health Systems Operating Division at Labcorp. Prior to that, he was senior vice president at Thrive Skilled Pediatric Care, and vice president of operations at AdaptHealth.  

Medline inks vendor deal with Vetter Senior Living 

NORTHFIELD, Ill. – Medline has announced a new prime vendor partnership with Nebraska-based Vetter Senior Living to serve as the primary supplier for its 30-plus facilities for an extensive portfolio of products and clinical solutions, including Skin Health Solution and Incontinence Management. "An important part of our mission of 'dignity in life' is to provide residents with everything they need to feel content by a team that works in a positive and encouraging environment,” said Heath Boddy, COO for Vetter Senior Living. “Our partnership with Medline goes beyond receiving boxes with products and helps us to provide team members with the tools and resources to provide the highest quality of care. We have more than 4,000 team members across all of the Vetter services lines and we appreciate Medline's willingness to come to our locations and share their clinical expertise." The two organizations began working together in 2023 when Medline rolled out its environmental services products, best practice education and therapy equipment at Vetter's facilities. "This agreement is a testament to our team's dedication and our ability to deliver value-driven solutions that enhance operational efficiency and patient care,” said Allen Amaral, senior vice president of long-term care corporate accounts, Medline. “We are excited to support Vetter through these specialized programs and look forward helping them continue their mission of exceptional care." 

Soleo Health names CIO 

FRISCO, Texas – Soleo Health has named Jason Weems to the newly created position of CIO to lead the company’s technology and digital strategy, with a focus on enhancing experiences for patients, providers, payers, manufacturers and employees. “We welcome Jason to the Soleo Health executive management team,” said Drew Walk, CEO. “This strategic addition to the executive team underscores Soleo Health’s commitment to leveraging cutting-edge technology to improve patient care and streamline operations across the enterprise. We are confident that Jason’s deep technology knowledge, broad management expertise and passion for enhancing our patient experience will help further elevate Soleo Health’s market leadership position in the complex specialty pharmacy space.” Weems will also oversee initiatives aimed at integrating innovative technology solutions for optimizing patient and provider engagement while concurrently improving service delivery across the organization. Weems has more than 25 years of health care information technology experience, including senior leadership roles at Cigna and Evernorth, where he led technology innovation efforts across various patient care and pharmacy business segments. He also previously held senior leadership positions at Express Scripts and Citi. “Soleo Health’s mission to simplify complex care deeply resonates with me as I have firsthand experience in personally navigating the health care system due to my daughter’s health challenges,” he said. “My new role affords me the chance to help drive meaningful change by leveraging innovative technology solutions that will accelerate our business objectives.” 

ATLAS taps CRT expert for exec role 

LAS VEGAS – ATLAS Technology has named Bret Tracy as executive vice president of operations. Tracy has been in the complex rehab technology and DME field for more than 24 years. Before joining ATLAS, he held senior leadership positions with several manufacturers, including Pride/Quantum Rehab, MK Battery and most recently Merits Health Products. “We are excited to have Bret join our team as EVP of operations,” said Bill Paul, president/CEO and owner of ATLAS Technology. “His extensive knowledge and professional experience in HME/CRT bring exceptional skills to the ATLAS clients and their patients. With our ‘Provider Support Eco System’ of products and services, Bret will continue his passion by helping the provider serve the patient with the latest technology, ensuring the patient gets the correct equipment in less time.” Tracy is currently on the board of directors for NCART and was previously on the board of ALS of South Carolina, ALS of Nevada, the Nevada Association of Medical Product Suppliers (NAMPS), the California Association of Medical Product Suppliers (CAMPS) and the Arizona Medical Equipment Suppliers Association (AZMESA). 

• Related: ATLAS also recently named Jason Dillon as vice president of sales. 

MediScan launches mobile phone app for custom orthotics 

TAMPA, Fla. – MediScan Custom Orthotics has launched a mobile phone application called MediScan that it says allows users to create the same medical-grade custom shoe inserts a podiatrist would normally prescribe, without the need to physically see a doctor. The company, which was founded by two Florida-based podiatrists and a longtime expert from the medical device industry, offers the same orthotic devices and custom shoe inserts a patient would normally receive from their podiatrist, without the burden of having to schedule and visit a doctor's office, the company says. These inserts can help with foot pain, foot aches, plantar fasciitis, flat feet, tendonitis, bunion prevention and general everyday comfort. “MediScan is about much more than providing the highest quality custom shoe implants to get patients up and moving again,” said Dr. Bret Brennan, a podiatrist and MediScan’s co-founder. “This is really an advancement for modern medicine, as a whole. We are combining the ease and convenience of telehealth with the creation of custom orthotics, drastically cutting the time it takes for patients to receive the solution that’s right for them. We’re thrilled to launch our mobile app today, and we’re excited to see our brand-new technology in action.” Within the app, users are guided through the creation of reliable 3D lidar scans of their feet using their phones or tablets. Those scans are then sent for review to a MediScan podiatrist who will then design the custom shoe implants based on the user’s unique needs. The finished product is then sent directly to the doorstep of the user, without the patient ever having to step foot in a doctor’s office.