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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News 6 www.HMENEwS.cOM / juNE 2016 / HME NEwS * Some restrictions apply. Call for details. * Some restrictions apply. Call for details. Above and Beyond Kay Johnson, owner of Midwest Medical services in Watertown, s.d., has been named the 2016 MaMes above and Beyond award winner. the award is given to MaMes members who go "above and beyond" in the fght to protect access to care. Johnson, who serves on several MaMes committees, invited sen. John thune, r-s.d., to participate in a meet- and-greet with MaMes members. pictured with pat naeger, MaMes president. to bill Medicare for the last two-and-a-half years, our revenue and profts continue to increase," he said. Meanwhile, some providers felt they had to accept the contracts to survive. "I hate to say (it), but we have no choice, even if it means these patients are going to get less care than ever," wrote another. one health system-owned HME company said it accepted Round 2 re-compete con- tracts so it can provide better care. It failed to receive contracts for Round 2, resulting in late discharges, longer lengths of stay and an but is now in writing. "It depends on your volume of claims, but this is a pretty common occurrence," van Halem says. Additionally, there's a new batch of SMRC audits, this time focusing on oxygen equip- ment, nebulizers and CPAP devices. The SMRC audits, which involve submit- ting additional documentation, are straight- forward but time consuming, especially for larger providers, says Stephanie Morgan Greene, a healthcare attorney who's execu- tive vice president of business development for ACU-Serve. "our larger clients that have multiple NEWSpOll C o n t I n u e d f r o M pa g e 3 REvIEW OF REGulATORy cHANGES C o n t I n u e d f r o M pa g e 3 locations are getting SMRC audits for each location for each of the product categories," she said. "one client has received its 10th audit at 40 claims a piece. It's a lot of work." on the other end of the spectrum: The RACs have started rewarding providers with low error rates by exempting them from certain audits. Three hundred and thirty PTAns have received exemption let- ters in one or more categories in Jurisdic- tion C, says Andrea Stark. "We've also seen letters in Jurisdiction D," said Stark, a reimbursement consultant with MiraVista. "We're defnitely seeing that in action." hme WASHINGTON – Twelve percent of HME claims for new patients, on average, were subject to MAC prepayment audits in the fourth quarter of 2015, according to data collected through AAHomecare's HME Audit Key. Drilling down by product category, 22% of hospital beds, support surfaces and manual wheelchair claims were subject to audits, fol- lowed by 16% of orthotics and prosthetics, and 14% of respiratory equipment. "These results are a frst step in a com- prehensive effort to collect data that dem- onstrates the burdensome nature of audits, in terms of volumes and overturn rates," AAHomecare stated in its weekly bulletin. nationwide, 78% of providers appealed denials, with o&P; leading the way with a 98% appeal rate, followed by ostomy, urologi- cal and wound care supplies at 87%. Upon review, 60% of claims for hospital beds, support surfaces and manual wheel- chairs were paid. For o&P; and respiratory equipment, 15% and 74%, respectively were paid. AAHomecare went live with the HME Audit Key earlier this year. Prior to its launch, the association raised $250,000 to develop the tool. hme Tool provides frst look increased chance of readmissions. "The Round 2 re-compete allowed us to bid aggressively to be able to support the con- tinuum of care throughout our community and ensure timely, fuid and safe discharges," the respondent said. "While the margins are thin, the outcomes will counter the risk asso- ciated with fragmented providers." Those who accepted contracts say they're committed to making it work. "We will look into getting price conces- sions from vendors; scale down our work- force; deliver less; and seek operational effciencies," said another respondent. "We will also look to continue focusing on non- Medicare patients and non-bid items." hme