HME News

AUG 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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News 4 www.hme N ews.com / august 2017 / hme N ews Mike Mallaro presents Dr. Kirsten Davin with the 2016 HME Woman of the Year award. Where community meets opportunity Nominate yourself or a peer today! www.vgm.com/hmewomanoftheyear Help VGM honor one of the many women whose passion and contributions continue to shape the industry. By l iz Beaulieu, e ditor S URE , GETTING the money they're owed will be great, but are HME providers ready to process claims that have been adjusted due to a retroac- tive delay to reimbursement cuts in non- competitive bidding areas? "There are, surprisingly, a lot of internal process considerations," said Andrea Stark, a reimbursement consultant for MiraVista, who hosted a webcast recently on how pro- viders should be preparing for the adjust- ments. "These are going to be some of the more complex claims in your system." N689, a recently announced remark code that will allow providers to identify adjust- ments will help (see related story), but other process considerations include how provid- ers handle others payers and patient co-pays. o ther P ayers "In North Carolina, for example, Medicaid has an allowable that was above the July 1 rates, but now they're below the Cures adjusted rate—that will result in Medicaid recoveries," Stark said. "Now Medicaid has Cures adjustments require planning overpaid for a couple of services. I don't know how materially that will be felt, but these are the kind of scenarios providers have to figure out." Pat I e N t co- P ays "Do you go back to patients and ask for the portion of co-pays you're owed?" Staked said. "There's no right or wrong answer, but each has its consequences. If you pur- sue it, prepare to have confused and angry patients asking you, 'Why are you collect- ing on this?' You also have to ask yourself how much you're going to spend trying to collect 20% of a 20% adjustment. But you are entitled to that money." g et out the 'e LB ow grease' Stark advised providers to take time in June and even July, before the DME MACs start processing adjustments on a daily basis, to put a plan in place. "They need to make sure they've thought through all the angles," she said. "This is not a Publishers Clearing House prize, where they show up at the door and give you a cardboard check. It's going to take some elbow grease." hme floor on Tuesday for some quick looks at specific items, then hopefully I'm on a plane on Tuesday night and back to work on Wednesday," wrote one respondent. "In these decreased reimbursement days, we try to save money any way we can." Although this year's show will be shorter, respondents said there's still a lot to get done. They want to get updates on the lat- est legislative and regulatory issues; they want to learn about new business pro- cesses; they want to see new and updated products; and they want to rub elbows with their peers. "I go for the education and to see what other companies are doing," wrote James Long of Littleton Respiratory Homecare in Wilmington, Ohio. "If I learn one thing, it can make a huge difference to my business. It really is one of the few chances I have all year to work on the business, instead of working in it." One challenge that remains for attend- ees, respondents say: balancing time in the educational sessions and in the exhibit hall, which often overlap. "We want to learn more about cash/retail opportunities and see retail products," wrote Randy Ford of TMD in Phoenix, Ariz. "The challenge is going to seminars and covering the exhibit hall at the same time." hme m E d TRA d E c o n t i n u e d f r o m pa g e 3 LETTERS c o n t i n u e d f r o m pa g e 3 "Every month that goes by, we are los- ing critical mass," said Tom Ryan, presi- dent and CEO of AAHomecare. "For every business that closes, there is going to be a patient access issue." Still, stakeholders say they are encouraged by some positive signs. The agency recently released its pro- posed 2018 changes to the End-Stage Renal Disease Prospective Payment Sys- tem, and it contained no DME-related provisions. "There's speculation that there is work going on for a separate regulation that would make improvements to the bid- ding program," said Bachenheimer. "I don't have any idea how quickly we will see either an interim final rule or a pro- posed rules or some other indication they are moving forward." While stakeholders are currently pressing for a regulatory fix, they are prepared to go the legislative route if necessary, they say. "We are growing short of time for the announcement of the next round of bidding," said Jay Witter, senior vice president of public policy. "We continue to work with our champions and they are poised to do something legislatively whenever the time is right." hme

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