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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Newspoll: Appeals backlong drags on . . . . . . . . . . . . . . . . 1 Prior auth legislation could nudge CMS forward . . . . . . . . 3 CareCentrix bends 'cost curve' . . . . . . . . . . . . . . . . . . . . . . 3 Medtrade shortens show . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 ■ AAHomecare's Tom Ryan called on stakeholders to reach 150 signatures for a letter demanding bid relief. See story this page. News www.hme N ews.com / july 2017 / hme N ews 3 s mall Business c ommittee goes to bat for hme WASHINGTON – The House Small Business Committee is asking Health and Human Services Secretary Tom Price for relief for HME providers. Committee member Rep. Blaine Luetkemeyer, R-Mo., is circulating a letter addressed to both Price and CMS Administrator Seema Verma, expressing concern with a 38% reduction in the num- ber of HME suppliers since July 1, 2013. The letter seeks: additional resources to speed up fee schedule adjustments re- quired by the 21st Century Cures Act; a delay in cuts that went back into effect in non-bid areas on Jan. 1, 2017; and a resto- ration of payments for oxygen concentra- tors in rural areas based on adjusted fee schedules. c linicians speak out on bid program WATERLOO, Iowa – People for Quality Care, the advocacy arm of The VGM Group, has released a video featuring damning testimony from clinicians on Medicare's competitive bidding program. The clini- cians provided the testimony at an an- nual conference recently hosted by Handi Medical Supply in Saint Paul, Minn. "Our goal is to empower the industry with the tools needed to continue the fight as we work together toward relief, said Kelly Turner, executive director of PFQC. "This video reinforces the message shared by the industry and other stakeholders that the program is harming the very people it's designed to protect." AA h elects new leaders WASHINGTON – AAHomecare elected new leadership during its annual member- ship meeting at the Washington Legisla- tive Conference in May. Steve Ackerman, CEO, Spectrum Medical, is chairman of the board of directors; Bill Guidetti, executive vice president, East Zone, Apria Healthcare, is vice chairman; and Jeff Hall, president of Reliable Medical Supply, is treasurer. Laura McIlvaine a board member with Shield Healthcare, has joined the board; and Doug Coleman, CEO of Rocky Mountain Medical Equipment, Major Medical Supply & UCH Home Medical Supply, has joined the board and executive committee. w hat do m edicare beneficiaries spend on health care? WASHINGTON – More than one-quarter of Medicare beneficiaries, or 15 million peo- ple, spend 20% or more of their incomes on premiums plus medical care, accord- ing to a new report from the Common- wealth Fund. Overall, beneficiaries spent an average of $3,024 on out-of-pocket costs. Of that, more than one-third was spent on cost-sharing for care, 25% on prescription drugs, and 39% on services not covered by Medicare, including dental and long-term care. The study also found that one-quarter of beneficiaries are un- derinsured, spending at least 10% of their total annual income on medical care, ex- cluding premiums. By Liz Beau L ieu, e ditor WASHINGTON – The timing of AAHomecare's Washington Legislative Conference couldn't have been better, Tom Ryan told attendees on May 24, the day before their Capitol Hill meetings. The day before, on May 23, a "Dear Colleague" letter began circulating on the Hill appeal- ing to Tom Price, secretary of the Department of Health and Human Services, and Seema Verma, CMS administrator, to intervene and provide relief from Medicare's competitive bidding program. By Liz Beau L ieu, e ditor WASHINGTON – Forcing Medicare to better coordinate audits and improve the appeals process is one of the top priorities of the Senate Finance Committee this year, Kimberly Brandt told attendees at the AAHomecare Washington Legislative Confer- By T. F L aher T y, Managing e ditor WASHINGTON – AAHomecare hopes a new bill will be the legislative push for CMS to speed up a prior authorization process for certain HME. Rep. Marsha Blackburn, R-Tenn., introduced H.R. 2445, the DMEPOS Access and Transparency Act of 2017 or DATA Act, on May 17. The bill follows a prior authoriza- tion process being in place for power mobility devices since 2012, and a process being in place for two complex power wheelchair codes since March of this year. "I think having legislation will make it easier for CMS to embrace and move for- ward with doing some of those prior authorization processes that aren't as similar to how the process for PMDs works," said Kim Brummett, vice pres- ident of regulatory affairs for AAHomecare. "I know CMS feels logistically hand-tied by what they feel they have the authority to do." Back in 2015, CMS issued a final rule that would establish a prior authorization process for certain high-priced HME, saying it would work off of a "master list" of 135 codes. But it wasn't until 2017 that the agency picked the ball back up and selected two codes from that list—the two complex power wheelchair codes—for prior authorization. AAH's Ryan: 'We are so close' capitol event "There's no score or proce- dure (required of this letter)," said Ryan, president and CEO of the association. "It's a simple ask. Look (your representative) in the eye and ask them to sign this letter." The letter, spearheaded by Rep. Cathy McMorris Rodg- ers, R-Wash., and five other representatives, asks Price and Verma to use their administra- tive authority to, among other things, freeze reimbursement in non-bid areas at the Jan. 1, 2016 rates. While providers may be frustrated by the lack of action thus far from Price, a long- time industry champion, Ryan reminded them that HHS is a large agency and that DME Industry stakeholders hit the Hill with letter to appeal for bid relief Senate committee prioritizes audit, appeals reform ence in May. The committee plans to con- duct a hearing for its AFIRM Act this summer, setting the stage for the bill to be re- introduced later this year, said Brandt, chief healthcare investigative counsel for the committee. Prior authorization legislation could nudge CMS forward With prior authorization seen as a key way to help rein in excessive audits, that's not fast enough, AAHomecare says. Additionally, Blackburn's bill would also exempt claims that have been approved through the prior authoriza- tion process from pre- and post-payment audits. "We're still going to have reviews where they are look- ing for proof o f d e l i v e r y or required d o c u m e n t a - t i o n , " s a i d B r u m m e t t . "But the med- ical necessity piece of the audits has always been the most subjective, so taking that away is huge." Blackburn's bill is similar to a previous version introduced in 2015, but it adds a provi- sion requiring a more detailed prior authorization process for respiratory equipment. Per the provision, the Department of Health and Human Services would establish a standard for medical necessity evalua- tion requests for physicians, hospital referral agents and non-physician practitioners. "The respiratory folks were very clear that they want it to be prescriber-driven so that the supplier isn't always caught in the middle," said Brummett. hme d c f ly- i n s e e pa g e 1 5 A u d I T r e f o r m s e e pa g e 1 5 c O S T c u r v e s e e pa g e 4 CARECENTRIX BENDS 'COST CURVE' By Liz Beau L ieu, e ditor HARTFOR d , c onn. – HME providers may view CareCentrix's recently announced partner- ship with Peformant as just another layer of scrutiny, but a company official says it will go a long way toward moving more care into the home. CareCentrix announced in late May that it will work with Performant, Medicare's national RAC for DME, home health and hospice, to deploy specialized analytics and algorithms to better identify and decrease waste and fraud. Partnership with Performant will decrease waste, create higher-performing networks, company says "The intent here is not for this to be a nega- tive experience," said Stephen Wogen, the chief growth officer at CareCentrix. "I'm in a lot of conversations with a lot of payers and health systems, and DME is misunderstood. I think the industry is under siege because of historical bad practices, and a lot of that has been cleaned up, but it still needs to over- come a bad rap. We at CareCentrix believe the future of health care is in the home. But for that to be leveraged, home care needs to be accountable and reliable, and providers need to be trusted." It's hard to ignore DME and home health as high-risk areas for waste and fraud, Wogen says. Not when CMS says they represent more than $11.4 billion in improper pay- ments each year for Medicare alone. CareCentrix already has analytics and compliance and special investigative teams in place to detect waste and fraud in its 10,000 provider locations. But the partner- ship allows the company to combine its exist- ing efforts with Performant's much larger data set, Wogen says. "We weed out players where we're seeing patterns of fraud, so we believe we Kim Brummett

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