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
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Medicare Market Marker The RemitDATA Denial Tracker SOURCE: REMITDATA: 901-767-9830 The RemitDATA Denial Tracker is an index of the percentage of Medicare and commercial claims rejected on a monthly basis. The most recent month's data represents an analysis of ap- proximately 1,703,394 Medicare claims and 3,193,375 commercial claims adjudi- cated between June 1, 2015, and June 30, 2015. The index is a categorized and weighted analysis of claims fi led by RemitDATA customers. HMENEWS.COM NewsPoll based on 70 respondents. 9/14 10/14 12/14 3/15 6/14 6/15 5/15 1/15 11/14 2/15 4/15 7/14 8/14 Most viewed stories in June 1. Providers to CMS: Yes, please drop CMNs 2. CMS overhauls vent product category 3. Humana, CareCentrix join audit free-for-all 4. Juggling act: Bidding, prior auths, accessories all in play 5. Bill provides ammo for audit reform 6. CMS stands fi rm on accesssories *The Medicare Market Marker provides a monthly look at the number of Medicare benefi ciaries for whom the four MACs have allowed a claims payment. SOURCE: PDAC (number of allowed benefi ciaries) E 1 3 9 0 : O X Y G E N C O N C E N T R A T O R E 0 2 6 0 : S E M I - E L E C T R I C H O S P I T A L B E D (number of allowed benefi ciaries) E 0 6 0 1 : C P A P (number of allowed benefi ciaries) K 0 0 0 1 : S T A N D A R D W H E E L C H A I R (number of allowed benefi ciaries) (number of allowed benefi ciaries) K 0 8 2 3 : P O W E R W H E E L C H A I R * * 4/14 1/15 12/14 2/15 3/14 5/14 6/14 10/14 11/14 7/14 8/14 9/14 HME NEWS POLL HMEDATABANK.COM The HME DataBank has the latest Medicare reimbursement data for the top 1,000 HME providers nationally in 103 key product cat- egories, as well as for all of the products in the NCB program. You can determine your market share, look for new product opportu- nities and check out your competition using the latest available Medicare data. Go to hmedatabank.com to learn more. data! data! Have you stopped fi ling appeals due to the backlog at the ALJ level? **We are now tracking K0823 claims with certain modifi ers (NU, UE or RR/KH) to better refl ect the actual number of new allowed benefi ciaries under the 13-month capped rental. 4/14 1/15 12/14 2/15 3/14 5/14 6/14 10/14 11/14 7/14 8/14 9/14 4/14 1/15 12/14 2/15 3/14 5/14 6/14 10/14 11/14 7/14 8/14 9/14 4/14 1/15 12/14 2/15 3/14 5/14 6/14 10/14 11/14 7/14 8/14 9/14 4/14 1/15 12/14 2/15 3/14 5/14 6/14 10/14 11/14 7/14 8/14 9/14 "We are no longer sup- plying items that would warrant ALJ appeals. Appeals currently with the ALJ are considered a loss." —Donna Barraclough, Apple West Home M e d i c a l S u p p l y, Emeryville, Calif. "The entire process creates an amazing amount of waste of time and ineffi ciency." —Kevin Metz, Metz Medical, Kenosha, Wis. HME NEWS / AUGUST 2015 / WWW.HMENEWS.COM 23 Databank If you're no longer fi ling as many appeals, how are you handling denied claims? Rehab (23, 18.9) DME (19.7, 17.0) Respiratory (14.5, 11.0) 223,357 Region C 132,100 Region D 107,880 Region B 82,019 Region A 22,805 Region C 19,716 Region A 7,334 Region D Region B 17,501 Region B 39,662 Region D 45,078 Region C 70,938 Region A 30,554 324 Region D Region B 253 650 Region C Region A 216 35,030 Region C 15,416 Region B 14,686 Region D 17,739 Region A Month Percent denied Source: The Braff Group, 412-833-5733. The Braff Group M&A; Insider Private Equity Investment Activity in HME vs. other Health Care Service Sectors This month, we take a 10-year retrospective look at private equity investment (platform and follow-on deals) in home medical equipment vs. all the other healthcare service sectors we track (home health and hospice, pharmacy services, behavioral health and healthcare staffi ng). As we can see, the trends have been meaningfully different. Excluding HME, if you were to adjust for the recession-driven dip between 2008 and 2009 and the dip in 2013 after a year juiced with favorable tax treatment, PE investing in healthcare services has risen more or less steadily for a decade. But not so in HME. The sector lagged behind until 2009 and then rose dramatically through 2012, after which there was a meaningful decline. The reasons? While the nationals dominated the scene, PE was content to remain on the sidelines. However, after the DRA and O2 caps slowed down the nationals, PE saw a window to fi ll the void in an uncertain (and less expensive) market. While we often see multiple waves of "me-too" investors, PE's move into HME has proven to be far more of a niche strategy. Not surprisingly then, without many other fi rms starting a new cycle, we are in the midst of a post-ramp up, leveling off of activity.