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 1,670,527 Medicare claims and 3,654,918 commercial claims adjudi- cated between April 1, 2016, and April 30, 2016. The index is a categorized and weighted analysis of claims fi led by RemitDATA customers. HMENEWS.COM NewsPoll based on 24 respondents. 7/15 8/15 10/15 1/16 4/15 4/16 3/16 11/15 9/15 12/15 2/16 5/15 6/15 Most viewed stories in April 1. NewsPoll: Are bid contracts worth it? 2. Bid bill has sticking point in the House 3. Bid rates divide mobility providers 4. Insurers follow Medicare's lead on vents 5. Diabetes group calls on Congress to #SuspendBidding 6. New ATP test offers chance to set new bar 7. Inogen sweeps majority of bid areas *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 * * 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 identifi ed overpayments so far this year? **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. 2/15 11/15 10/15 12/15 1/15 3/15 4/15 8/15 9/15 5/15 6/15 7/15 "The latest round of rules and discus- sions over this bog- gles my mind. With prior authorization, pre- and post-pay- ment audits of every acronym, and rejec- tions with multilevel appeals, how are there possibly any mistakes left for us to fi nd and voluntarily refund?" —Lori Sears, owner, Active Home Medical Supply, Lapeer, Mich. HME NEWS / JUNE 2016 / WWW.HMENEWS.COM 23 Databank 235,691 Region C 136,405 Region D 115,837 Region B 88,471 Region A 28,136 Region C 22,168 Region A 7,732 Region D Region B 17,875 Region B 48,513 Region D 55,890 Region C 90,958 Region A 39,470 340 Region B Region D 288 1,038 Region C Region A 259 41,944 Region C 18,231 Region B 15,778 Region D 20,395 Region A Month Percent denied Source: The Braff Group, 412-833-5733. The Braff Group M&A; Insider Rehab (22.6, 19.4) DME (15.7, 17.5) Respiratory (13.5, 11.2) How many overpayments per NPI (not aggregate) do you typically identify in a given year? 2/15 11/15 10/15 12/15 1/15 3/15 4/15 8/15 9/15 5/15 6/15 7/15 2/15 11/15 10/15 12/15 1/15 3/15 4/15 8/15 9/15 5/15 6/15 7/15 2/15 11/15 10/15 12/15 1/15 3/15 4/15 8/15 9/15 5/15 6/15 7/15 2/15 11/15 10/15 12/15 1/15 3/15 4/15 8/15 9/15 5/15 6/15 7/15 This month, we revisit trends in total acquisition debt capacity—expressed as multiples of EBITDA. These multiples are broken down into two classes: senior debt and subordinated debt. As the names imply, senior debt is fi rst lien debt, which means in the event of default, senior lenders get paid fi rst. Subordinated debt, on the other hand, is second level debt, which, in the event of default, is paid after senior debt obligations have been fulfi lled. Not surprisingly, given its higher risk, subordinated debt capacity is substantially less than senior—and is also more expensive. Now that we have the defi nitions out of the way, this chart represents debt levels at the lower end of the middle market—deals valued between $10-250M. Notably, while subordinated debt thresholds have remained basically level, senior debt capacity has risen 25% since 2011. As a result, not only is it that much "easier" to fi nance a deal, the added "leverage" enables private equity to pay more for companies and still meet their internal benchmark rates of return. This, in part, has contributed to a modest uptick in valuations over the same period. Source: GF Data Leverage Report; February 2016; www. gfdataresources.com