HME News

MAR 2017

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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Mobility HM e new S / MARCH 2017 / www. HM enew S . C o M 19 Stakeholders await instructions ANNUAL f L y- IN c o n t I n u e d f r o m pa g e 1 to create a separate benefit for complex rehab. "We're getting everything lined up," he said in January. "We're working with the same sponsors as last year on the mechanics of getting the bills introduced and we're working on re-securing co- sponsors for them." T h a n k s t o l e g i s l a t i o n p a s s e d i n December, CMS's plan to apply bid pric- ing to accessories has been delayed until June 30, giv- ing stakeholders a small window to get a more perma- nent fix through Congress. l a s t y e a r , N C A R T a n d N R RT S h i t c h e d their event to the a n n u a l R E S N A c o n f e r e n c e . b ecause this year's R E S N A c o n f e r- ence will be June 26-30 at the Hil- ton Riverside in New Orleans, the groups decided to return to holding their own event, though Clayback says he will be attending and participating in the RESNA conference. Also, that doesn't mean the three groups won't partner again in the future, Clayback says. "Every year their event is in a different location, and every year we want to be in Washington, D.C., to carry on our mes- sage with Congress," he said. "We're still talking about potential plans for 2018." Attendees will be able to register for the fly-in through NCART or NRRTS soon. hme K 0108 LIMITS c o n t I n u e d f r o m p r e v I o u s pa g e this practice "unbundling," that's no lon- ger an option, stakeholders say. "The article claims that by using the K0108, a provider would be 'unbundling' charges, which is not allowed," said Clau- dia Amortegui, president of The Orion Consulting Group. "They also then can- not bill the extra charge as an upgrade. This philosophy would go against the principals of the upgrade provision. Sim- ply put, the end-users' right to choose has been taken away, if they want to pay the difference to obtain specific features and options." Now the only choice providers have is to bill non-assigned for manual wheelchairs with titanium and heavy duty upgrades, leaving beneficiaries to pay upfront for the total cost of the chair and to try to wrangle reimbursement for the chair, but not the upgrades, from Medicare. "It's unfortunate," said John Goetz, director of government affairs for Permo- bil. "A lot of people can pay the differ- ence, but they can't pay the whole amount upfront." NCART has formed a work group and developed an issue paper in response to the change. It is reaching out to CMS to express its concerns and is pursuing "other channels in the congressional and advocacy arena," it stated in a bulletin to members. In the issue paper, NCART pushes CMS to rescind the change, and issue a poli- cy clarification stating suppliers can use K0108 to bill for titanium for wheelchairs for K0005, and can use K0108 to bill for heavy duty upgrades for K0004, K0005 and E1161. hme NUMOTION c o n t I n u e d f r o m p r e v I o u s pa g e collegiate hockey game. Swinford said employees were so enthralled by the two speakers, "you could hear a pin drop in a crowd of 650 people." The conference also featured an expo hall with exhibitors for employ- ees to familiarize themselves with new products and technologies, and a com- munity service activity. For this year's activity, employees provided more than 1,000 man-hours of maintenance work at Give Kids the World Village, a nonprofit resort in Kissimmee, Fla., for children with life-threatening illnesses and their families. The resort's focus is provid- ing accommodations and access to donated theme park tickets. "To see how dedicated our employ- ees are—every year, it's a highlight of the meeting," Swinford said. Swinford says the conference and the level of energy and engagement it creates helps Numotion excel in "five key business imperatives," including growing the number of customers it serves. He says Numotion serves 250,000 customers right now and plans to serve half a million in the next three to four years. "Our culture has never been stron- ger," he said, "and the health of our business has never been better." hme f IVE KE y S c o n t I n u e d f r o m p r e v I o u s pa g e year. "We're a week or two away from announcing an exclusive partnership with a manufacturer that will allow us to bring a one-of-a-kind technology to the U.S.," he said in late January. gR ow TH Swinford says Numotion has a "huge pipeline of acquisition candidates" for 2017. "We expect to be very active this year," he said. "As long as it's a good fit culturally, and from a process perspec- tive, it's a group of quality individuals, we're absolutely interested." hme A bill has been introduced in the House of Representatives to create a separate benefit for complex rehab just in time for the event (see brief). Still to come: a bill to prevent CMS from applying bid pricing to wheelchair accessories. By Liz Beau L ieu, e ditor WASHINGTON – The cancellation of a Jan. 26 Spe- cial Open Door Forum on the upcoming prior authorization process for two complex rehab codes means industry stakeholders will have to wait longer to get their concerns and ques- tions addressed. During the forum, CMS was to outline the process for submitting a PA request to the des- ignated Medicare Administrative Contractor, the timeframes for the MAC to render its deci- sions and the process for subsequent claim submissions. "It's all unknown territory until CMS releases instructions," said Martin Szmal, founder of The Mobility Consultants. CMS in December announced K0856 and K0861 as the first two codes that will require NEW PRIOR AUTH PROCESS FOR TWO COMPLEX REHAB CODES PAs. On March 20, it will apply the require- ment to one state in each of the four DME MAC jurisdictions; on July 17, it will expand the requirement nationwide. CMS does have a PA process already up and running in 19 states as part of a demonstration project, mainly for standard power wheelchairs, though there are some Group 2 complex rehab codes included. Chief among the concerns stakeholders have is the difference between the PA process and the ADMC process currently being used to help ensure payment for complex power wheelchairs. In the PA process, stakeholders suspect the clock will not stop on the 120 days that providers have to deliver products from the time of the face-to-face evaluation. In the ADMC process, providers have a six- month window to deliver equipment. "Now, more than ever, the supplier's docu- mentation needs to be able to 'pass' the PA review on the first submission to ensure timely delivery of the equipment," Szmal said. The people reviewing claims as part of the PA process also have a different "skill set" than those reviewing claims as part of the ADMC process, stakeholders say. "The ADMC reviewers have in-depth clini- cal knowledge," said Sylvia Toscano, owner of Professional Medical Administrators. Stakeholders also pointed out that the ADMC process covers the base and accesso- ries of a wheelchair. "Are they going to expand the prior autho- rization to include all the codes that make up the chair?" Toscano said. "If they're just approving the base and if the accessories are not medical necessary, then is the base not medically necessary?" hme

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