HME News is the monthly business newspaper for home medical equipment providers. This controlled circulation publication reaches 17,100 home medical equipment services providers, including traditional HME dealers & suppliers, hospital- and pharmacy-o
Issue link: https://hme.epubxp.com/i/542639
■ ■ Industry juggles multiple priorities this summer, says VGM's John Gallagher. See story page 1. Stakeholders wait on audit bill. . . . . . . . . . . . . . . . . . . . . . . 3 Bid lawsuit inches forward . . . . . . . . . . . . . . . . . . . . . . . . . . 3 AAHomecare seeks to grow membership . . . . . . . . . . . . . 3 NewsPoll: Medicaid cuts are pervasive. . . . . . . . . . . . . . . . 3 Briefs Gov't announces historic takedown WASHINGTON – A nationwide sweep led by the Medicare Fraud Strike Force has re- sulted in charges against 243 individuals, including 46 doctors, nurses and other licensed medical professionals. The indi- viduals have been charged for their alleged participation in Medicare fraud schemes involving about $712 million in false bill- ings, the Department of Health and Human Services announced in June. "The defen- dants charged include doctors, patient re- cruiters, home health care providers, phar- macy owners, and others," said Attorney General Loretta Lynch. GAO fnds fragmented oversight of Medicaid WASHINGTON – CMS needs to do a better job overseeing Medicaid managed care, the Government Accountability Offce says in a report released June 18. The GAO found that the program integrity units of fve states and the Medicaid Fraud Control Units of seven states that were included in its review focus their efforts on Medicaid fee-for-service pay- ments, not Medicaid managed care pay- ments. This, the GAO says, despite the fact that Medicaid managed care is growing at a faster rate than fee-for-service. Hospitals take up CMS on offer. Will HME providers get their chance? WASHINGTON – Recent settlements of pend- ing appealed claims between CMS and hospitals have given stakeholders hope that a settlement with HME providers is also possible. As of June 1, CMS has paid $1.3 billion from the Medicare Trust Fund to settle 300,000 pending appealed claims from more than 1,900 hospitals, accord- ing to an update. Back in August, CMS offered "an administrative agreement to any acute-care hospital or critical access hospital willing to resolve their pending appeals (or waive their right to request an appeal) in exchange for timely partial pay- ment (68% of the net payable amount)." CMS rethinks miscellaneous codes WASHINGTON – CMS is proposing new codes to describe miscellaneous DME to refect more accurate payment of Medicare claims. HCPCS codes E1399 and K0108 are cur- rently used to bill for inexpensive items; however, the agency proposes to replace them with new codes effective Jan. 1, 2016. People news AAHomecare has named Ashley Plau- ché to the newly created role of manager of government affairs. She will manage three association councils and provide support on government relations initia- tives. Plauché was the director of com- munications and public relations for her family's business, Lambert's Health Care in Knoxville, Tenn. WWW.HMEnEWS.COM / AuGuSt 2015 / HME nEWS 3 news By Theresa FlaherTy, Managing editor WASHINGTON – Industry stake- holders say, despite slow prog- ress, the reintroduction of an audit reform bill is still a "high priority." They had hoped to see Rep. Renee Ellmers, R-N.C., drop the bill this spring. "Obviously, we wanted it sooner than this," said Beth Bowen, executive director of the North Carolina Association of Medical Equipment Services, who's been working with Ellm- ers on the bill. "It's still in the works, still a high priority." The hold up? At least one member of the House Ways and Means Committee has issues By liz Beaulieu, editor WASHINGTON – The federal gov- ernment on June 25 had its last chance to weigh in on whether or not a court rul- ing in favor of Cardio- som should be applied t o o t h e r providers whose contracts were rescinded as part of the original Round 1 of competi- tive bidding. Following the fling of this fourth brief, Jerry Stouck, a Tracy orzel, associate editor A W H O p p I N g 7 0 % o f respondents to a recent HME Newspoll said their state Medicaid programs have reduced reimbursement in the past year. R e s p o n d e n t s s a y t h e s e reductions are making it dif- fcult to service patients, if it all. "This new cut means that, in many cases, we will not be able to continue provid- ing recipi- e n t s w i t h the equip- ment/sup- p l i e s t h a t they need," s a i d J e f f B u r k e t t , DME manager at Mount Ver- non, Ill.-based TMS Mobility & Rehab, which saw a 16.75% cut in Medicaid reimburse- ment rates in May. Of those respondents who reported a reduction in reim- b u r s e m e n t , t h e m a j o r i t y (50%) have seen reductions of 15% or more. Some states, like Rhode Island, have taken the extra step of reducing rates retroactively. "It's truly an unfair prac- tice," said one respondent. " p ro v i d e r s p e r f o r m w i t h the expectation of a specifc allowed amount, and then subsequently learn that the fee will be adjusted after the fact." Of the 30% of respon- dents who reported no re c e n t re d u c t i o n s i n M e d i c a i d re i m b u r s e - ment, 67% said their s t a t e M e d i c a i d p r o - gram is considering a reduction. Another looming possibil- ity: a provision included in the 21st Century Cures Act that would limit the federal portion of state Medicaid fee- for-service rates for HME to the Medicare competitive bid- ding rates. Even without reductions, some respondents say they're struggling to break even. "Our state hasn't raised reimbursement rates in more Stakeholders wait on bill Audit reform with a provision in the bill rein- stating clinical inference. This would allow audit contractors to make common sense judgments on whether claims should be paid, rather than denying them just because of technical issues. "If the bill is intro- duced without clini- cal inference it won't make any sense," said Tom Ryan, president and CEO of AAHomecare. "I think some of the pushback from the com- mittee is probably coming from lobbyists for the Recovery Audit Contractors." Since the elimination of clini- cal inference in 2009, error rates for HME have soared, from less than 10% of claims to more than 60% of claims denied for tech- nical reasons, stakeholders say. Ellmers' previous audit reform bill, introduced in July 2014, included a provision to reinstate clinical inference. M e a n w h i l e , t h e backlog of appealed claims at the Adminis- trative Law Judge level continues to grow, said Chief ALJ Nancy gris- wold during a forum on June 25. During the frst quarter of 2015, 128,000 appeals were fled, with an average process- ing time of 588.9 days, she said. "We are seeing sustained growth in appeals due to a number of factors," she said. "We've seen across-the-board increases not only from RACs, but also from other post-pay audit programs, more active state Medicaid agencies, and more benefciaries aging into the program." hme Bidding lawsuit inches forward Medicaid cuts add up AAHomecare tries to make it personal By liz Beaulieu, editor WASHINGTON – A businessman at heart, it doesn't sit well with Tom Ryan that AAHomecare's membership numbers have been flat for the past three years. That's why Ryan, the presi- dent and CEO of the asso- ciation, has enlisted Labora- tory Tactical Consulting to help bring in new members and help retain existing mem- bers. "AAHomec- a r e i s t h e umbrella that ties this industry together," he said. "We have to make sure we're a healthy, robust national association." AAHomecare and Labora- tory Tactical Consulting had a one-day meeting in June to review the association's pros- pecting and onboarding pro- cesses for members. In such a high-tech and social media-savvy world, one of AAHomecare's strategies to improve those processes will be personal communication, Ryan says. "We need to get on a call and tell them what we're doing and ask them what their biggest issue is, so there's a feeling of comfort and a sense of under- standing," he said. "Those one-on-one conversations are something we're working on." Technology has its place, though, and AAHomecare plans to use it to target cer- tain providers with certain information, like respiratory providers with information on recent comments submit- ted to CMS on vents, Ryan says. "It's just good member engagement," he said. The overarching goal is to make the ROI of being an AAHomecare member clearer, says Anna McDevitt, owner of Laboratory Tactical Consult- ing. "What are those value prop- ositions," she said. "When things are changing like they are, adaptability is really impor- tant. So we need to defne that value to membership." hme Anna McDevitt A provision reinstating clinical inference proves to be a sticking point 'We will not be able to continue providing recipients with the equipment and supplies they need." HME NEWS POLL l AW S u I T s e e pa g e 4 m e d I c A I d s e e pa g e 4 Jerry Stouck Beth Bowen