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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Rx and Specialty Providers 18 www. H me N ew S . C om / j U ly 2017 / H me N ew S WASHINGTON – r eps. Glenn "GT" Thomp- son, r -Pa., and Mike Thompson, D-Calif., have once again introduced a bill that calls on CMS to enforce a law that O&P providers be certified to receive payments under Medicare. Thompson and Thompson introduced H. r . 2599, the Medicare Orthotics and Prosthetics Improvement Act of 2017, in May. They have introduced similar bills in previous sessions of Congress. "Medicare beneficiaries in need of prosthetic and orthotic services deserve to know they're getting the very best care," said Mike Thompson in a press release. "Keeping fraudulent providers out of Medicare will ensure patients get the treatment they deserve, and has the added benefit of reducing costs." The Benefits Improvement and Protec- Bill tries to force CMS's hand on O&P certification tion Act (BIPA), which was signed into law back in 2000, requires certification for O&P providers. CMS has failed to enforce the provision, however, result- ing in an uptick in fraudulent payments to unlicensed providers, Thompson and Thompson say. The bill would also link eligibility for payment to the qualification of the pro- viders and the complexity of the device; establish orthotists and prosthetists as Medicare providers, distinguishing them from DME providers; and clarify that notes taken by orthotists and prosthe- tists should be part of the patient's medi- cal record. Congress adjourned late last year without passing the Medicare Orthot- ics and Prosthetics Improvement Act of 2015. HM access. To that effect, the provider recently launched a 24/7 sleep-coaching program and has seen compliance rates jump above the national average. "When we talk about quality we are really talking about patient adherence to therapy," he said. "At the end of the day, we have to tie that quality to outcomes." Another recent innovation: Persante ships CPAP equipment directly to the home and a respiratory therapist sets the patient up virtually, often by telephone. "Our surveys are telling us there is a good number of patients that want to receive their care this way," said LaPorta. "As with any new program there's a little disruption, but it's more convenient and we do still offer other options (like in- person set-ups)." As growing awareness of the impor- tance of sleep creates further expansion of the market, Persante will also contin- ue to grow its geographic footprint, says LaPorta. "Our focus will continue to be on sleep—the diagnostics and therapy," he said. "The epidemic of obstructive sleep apnea is an untapped market that needed to be addressed and Persante is really an expert on the subject of sleep." HME p ERSANTE IS ' EX p ERT ' ON SLEE p c o n t i n u e d f r o m pa g e 1 7 to pay cash instead, says provider Kermit Newman. "It's been increasingly difficult for patients to get resupplies paid through insurance," said Newman, CEO of Advanced Sleep Medicine Services. "We are seeing more and more saying they would rather pay cash than bother with the insurance." That's why Advanced Sleep recently added an e-commerce store to its website, www.sleepdr.com While many patients opt to pay cash, Advanced Sleep Medicine Services also accepts insurance for covered items, a key difference that sets it apart from other online sellers. Its website clearly states the need for a prescription for insurance and outlines the difference between pricing for cash and insurance transactions. "We use the cart system and it's very easy to use," said Elizabeth Bilbo, customer service manager. "If there's anything that about CPAP is that there's no risk to it. It's extraordinarily safe. The only thing you have to do is clean it regularly. Cleaning reduces risks of pathogens getting into the humidifier system and breeding. If that happens, then you're breathing that in very directly. HME: Are patients trained in how to clean the CPAP when they get the equipment? Krainin: At most DMEs, it's whatever information they have to share. If you read the instruction manual, you're going to read it should be cleaned. But it's not necessarily communicated to them. HME: What can CPAP providers do to needs follow up, they can do it right away with our customer service department via email or phone." Advanced Sleep Medicine Services has more than 20 years of experience in the sleep business, and it has provided educa- tion and information through its website for 10 years. "Our blog and our website have been around a long time," said Newman. "We have a lot of patients who have come to us through our blog who are just looking for general information." Newman says that, in addition to name recogni- tion, customers prefer the one-stop, specialized shop that Advanced Sleep Medicine Services offers. "People who are looking for a CPAP device or resupplies, that's what they need, that's what they are looking for," he said. "It's not important to them if a site is also selling wheelchairs." HM E K . Newman ONLINE SALES c o n t i n u e d f r o m pa g e 7 emphasize the importance of cleaning these machines? Krainin: In my practice we do make it a priority to talk about that. When set- ting realistic goals about the use, peo- ple should know they're going to have to replenish certain parts on a regular basis. That's also a good opportunity to talk about the importance of cleaning a machine and coming up with a plan to do that. HME: What about machines like SoClean that do the work of cleaning CPAP machines? Krainin: They take the guesswork out of "Did I do a good enough job?" It really comes down to: Do you want a dishwash- er, or do you want to wash all your dishes by hand? HME D R . KRAININ c o n t i n u e d f r o m pa g e 1 7 "We are a small business; if too many claims go to higher levels, this could jeop- ardize us staying in business," wrote Donna Barraclough of Apple West Home Medical Supply in Emeryville, Calif. "We evaluate our case and if we feel we can win, we continue to appeal. Most denials are for reasons that can usually be overturned at the higher lev- els. If we lose, we learn more ways to help us make sure that future claims pass audits. Hopefully we're still in business when our cases get to a judge. We recently won two cases from 2013." And therein lies the biggest frustration for many poll respondents: In the large majority of cases (as much as 90% of the time, accord- ing to stakeholder estimates), they win on appeal, meaning the claims should never have been denied in the first place. "It's very frustrating to see these same names over and over again on reports, ser- vicing them and knowing that you are not being paid a dime," wrote Ken Wells of Tuck- er-Wells Medical in Florence, S.C. "All of the claims were rejected for miniscule things or in error, and should have never been rejected." Despite their frustrations, poll respondents say they continue to appeal claims because they have few other options—and they do it on principle. HME A pp EALS DRAG c o n t i n u e d f r o m pa g e 1 We have been working on POCs for 16 years, have become the market leader, and have dedicated ourselves to designing POCs to be patient and provider preferred. Now with a 5 year warranty, there has never been a better time to evaluate POCs for your business. POCs MAY BE NEW TO YOU, BUT WE'VE HAD 16 YEARS OF PRACTICE 1-800-230-6227 Introducing a 5 year warranty* standard on the Inogen One G3 ® © 2017 Inogen, Inc. All rights reserved. *5 year warranty off ered to homecare providers with an active NPI number. See warranty statement for complete details. MKT-P0074 5 YEAR WARRANTY

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