HME News

JUL 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 h M e N e WS / july 2017 / WWW .h M e N e WS . COM 15 'Right equipment can help people achieve independence' By Jeff Rowe, Contributing w riter WASHINGTON – This summer, RespectAbil- ity, a Washington, D.C.-based nonprof- it, will mentor 12 young leaders from around the country who want to advance disability issues and who want careers in media, public policy and advocacy. h M e News recently sat down with co-founder Jennifer Laszlo Mizrahi to talk about the organization's successes and future goals. hme News: Why was RespectAbility formed in 2013? Jennifer Laszlo Mizrahi: We really felt the need to take the pity lens away from dis- Q&A: RespectAbility's Jennifer Laszlo Mizrahi ability and work for more employment opportunity and empowerment for maxi- mum success. hme : What have you accomplished in the past four years? What do you hope to accomplish in the next four years? Laszlo Mizrahi: We've met with 46 of America's governors to talk about how they could realign state programs to enable employment opportunities for the disabled. In particular, Gov. Scott Walk- er of Wisconsin and Gov. Tom Wolf of Pennsylvania have helped create thou- sands of new jobs for people with dis- abilities in their states. As for the next four years, we'd like to facilitate what we see as the rising awareness in h ol- lywood of the importance of including people with disabilities in their movies and TV programming. h m e : C a n y o u t e l l u s a b o u t t h e #RespectTheAbility campaign and what it has accomplished? Laszlo Mizrahi: We've focused on how hir- ing people with disabilities helps employ- ers make more money. Frankly, the dis- abled are often more loyal to employers and have more talent. hme : Why is it important to improve how the media portrays people with disabili- ties? Laszlo Mizrahi: Fairness toward the dis- abled community shouldn't be consid- ered simply an act of charity. Right now, viewers almost never see people with disabilities on TV. For example, 20% of the population is disabled and yet only 2% of actors on TV portray disabled characters. hme : How do you see the role of HME providers in helping people with physical disabilities live independently and achieve their professional goals? Laszlo Mizrahi: The right equipment can help people achieve independence. hme SEAT ELEVATION c o n t i n u e d f r o m p r e v i o u s pa g e SEAT ST udy c o n t i n u e d f r o m p r e v i o u s pa g e has stated the technology doesn't meet the definition of DM e because it's not medically necessary. "It's going to take a change in philosophy (at the agency)," said Julie Piriano, vice presi- dent of clinical education and rehab industry affairs, and the compliance officer for Pride Mobility Products. "We're looking for them to view seat elevation like power seat options or tilt and recline—an accessory that's medically necessary and serves a medical purpose." It's important to remember, stakeholders say, that while the excitement level around seat elevation technology is the highest it has ever been, the wheels at CMS move slowly. "We fully recognize that this is going to take time," Piriano said. "When ultra-light wheelchairs came out, there was no code and it wasn't covered. No one could see why someone would need a chair with an adjust- able axle and that was made of lighter weight materials." Because it will take time, stakeholders acknowledge they need to do a better job multi-tasking: They need to keep the pres- sure on CMS about seat elevation technol- ogy while they, at the same time, lobby the agency and Congress on more urgent matters, like permanently protecting accessories for complex power wheelchairs from competitive bidding related pricing. "We're always going to be fighting some battle," said Don Clayback, executive director of NCART, which hosted the conference with NRRTS. "So we have to make sure nothing gets lost." hme preparing meals. The new study expands the scope of the initial study with a larger participant group. "We want to make sure it's a true representation—across ages, disability types, geographical areas," Piriano said. The study will be key to industry efforts to get more widespread coverage for seat elevation technology. While this takes time, good research can speed it along. "For powered tilt, there was no code or coverage criteria at first," Piriano said. "But it took less time to get, because there was research behind it very quickly." hme cu SHION c O d ES c o n t i n u e d f r o m p r e v i o u s pa g e is the same. "The associated issues (balance, pos- ture, etc.) that follow these individuals with lower extremity amputations are the same regardless of how the amputation has come about," he wrote in the request. Szmal made the request after digging into the denials of several of his provider clients. "In the documentation, Z codes were being used to identify the amputation and those weren't listed in the policy," he said. In their response, the DM e MACs say they will include all but one Z diagnosis code in a future revision of the LCD. "ICD-10 Z89.9 will not be added as it can describe conditions that would not correctly justify claim payment," they wrote. "This code, being an unspecified one, could apply to upper extremity amputations, for instance, which would not be pertinent to this coverage." hme PA PRO c ESS c o n t i n u e d f r o m pa g e 1 of prior authorizations, as long as the pro- cess goes smoothly." It helps, stakeholders say, that CMS already has a PA process in place for stan- dard power wheelchairs as part of a dem- onstration project that's now running in 19 states. The agency worked with stakehold- ers early on to tweak the process to make it more manageable. Providers like Chuck Spiedel report that their PA requests for K0856 and K0861 are getting affirmed or non-affirmed within two weeks, a turnaround time they're pleased with. "That's reasonable," said Spiedel, the rehab manager for Personal Mobility in Springfield, Ill. " e ven managed care takes at least that amount of time." Providers like Doug Westerdahl also report that the majority of their PA requests for K0856 and K0861 are getting affirmed. Overall, his company's affirmation rate is 49%, but when he weeds out the requests for standard power wheelchairs that are part of the demo, it's probably higher than that, he says. "My guess is the approval rate for the com- plex rehab codes is 60% to 65% on the first try," said Westerdahl, president and C e O of Monroe Wheelchair in Rochester, N. y . e ven when their requests are non- affirmed, providers are typically able to get them affirmed with subsequent requests, they say. "The non-affirmations are usually due to transmission issues, not documentation issues," Spiedel said. "Like something got cut off in the fax and we need to resubmit." Providers do worry, however, that when CMS expands the PA process nationwide, it may strain the process. "I'm very worried about that," Westerdahl said. " Right now, if we don't get something back in 10 business days, we can call and find out if we've been approved or denied. If they tell us we're approved, we don't wait for the mail; we go ahead and order the chair." hme AAH ' S dc f L y- IN c o n t i n u e d f r o m pa g e 3 SENATE PRIORITI z ES A ud IT RE f OR m c o n t i n u e d f r o m pa g e 3 represents only 1.2% of its budget. "We are moving the needle at the top," he said. "We are so close." Ryan set as a goal getting at least 150 representatives to sign on to the letter fol- lowing the week's h ill meetings. "This letter is an opportunity to walk (bid relief) over the finish line," he said. The timing of the letter and leverag- ing its momentum was so important that AA h omecare prioritized more time for meetings on the h ill on the afternoon of May 24, in lieu of booking congressional speakers. "This year it's vital that we get you on the h ill, get out the ask and get signatures quick," said Jay Witter, the senior vice president of public policy at AA h omec- are. The letter also asks Price and Verma to consider more long-term fixes to make the competitive bidding program more "effi- cient and sustainable"; to permanently protect accessories for complex power wheelchairs from bid-related reimburse- ment cuts; and to reverse a recent "dou- ble-dip" cut to oxygen concentrators. "This is a letter (that contains) every issue we've been working on," Ryan said. hme "We hope to come out with finalized language no later than the fall," she said. But the challenge this year, as it was in 2015, when the bill was first introduced, is cost. The Congressional Budget Office gave the Audit & Appeals Fairness, Integ- rity and Reforms in Medicare Act of 2015 a $1.4 billion price tag. Despite that challenge, the committee remains dedicated to reform—the prob- lem is too big to ignore, Brandt says. The backlog at the administrative law judge level, the third level of appeal, is more than 700,000 cases deep, she pointed out, meaning if you submitted a case today, it would take more than 830 days to get a hearing. "That's unacceptably long," she said. "The ALJ can't solve cases fast enough." The committee also got reaffirmation recently, when a judge overseeing litiga- tion* related to audits and appeals between the Department of h ealth and h uman Ser- vices and the American h ospital Associa- tion said the AFIRM Act would go a long way toward solving issues, Brandt said. "We were pleasantly surprised by that," she said. While the specifics of the bill will likely be reworked this year, the overall goal is holding Medicare accountable for how it organizes and conducts audits, and over- sees its auditors, Brandt said. "There aren't even consistent standards that auditors are held to," she said. While the committee does its work, the industry partnered with Rep. Marsha Blackburn, R-Tenn., in May to introduce a bill that would require prior authorization for certain high-cost DM e . A provision in the bill would exempt approved claims from subsequent pre- and post-payments audits. "Prior authorizations are the way to go, in terms of a long-term fix," said Jay Wit- ter, senior director of government affairs for AA h omecare. hme Kim Bra N dt agrees that the "ALJ can't solve cases fast enough . "

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