HME News

JAN 2018

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. H me N ew S . C om / JAN u A ry 2018 / H me N ew S *Price valid through March 30, 2018 and includes education, meals, local transportation and entertainment. Heartland Conference 2018 SAVE THE DATE! June 19-21, 2018 (Pre-conference networking on June 18) Why YOU should attend VGM's Heartland Conference! • Earn approx. 20 contact hours of continuing education • Connect with industry experts and VGM thought leaders • Unmatched networking opportunities Where community meets opportunity Register now! www.vgmheartland.com ONLY $299* PER PERSON! By l iz Beaulieu, e ditor WASHINGTON – CMS has rolled out a new settlement option for low- volume appeals, but it's not likely HM e providers will take the agen- cy up on its offer, stakeholders say. Providers with fewer than 500 appeals pending at the Office of Medicare Hearings and Appeals and the Medicare Appeals Coun- cil combined as of Nov. 3, 2017 with a total billed amount of $9,000 or less per appeal could be eligible, if certain other condi- tions are met. The kicker: CMS will settle eligible appeals at 62% of the net allowed amount. "It's a tricky situation," said Andrea Stark, a reimbursement consultant with MiraVista in Columbia, S.C. "We need the cash now, in light of reimburse- ment cuts, so we might be tempt- ed to take 62%, but if we really do Settlement: Non-option option for ALJ appeals expect most claims to be reversed favorably, we get 100%. That's the give and take." Ross Burris, an Atlanta-based healthcare attorney with Polsinelli, put it this way: "You have a better shot of getting everything during an ALJ hearing—if you can wait, and that wait is now almost three years." The low-volume appeals settle- ment follows similar offers to acute care and critical care access hospi- tals to resolve pending appeals in exchange for timely partial payment of 68% of net payable amount. Another drawback of settling, says Wayne van Halem, president of Atlanta-based The van Halem Group: Claims remain denied in the system, meaning any subse- quent claims for related supplies, for example, also remain denied. "It's not a discussion about medi- cal necessity—it's just a discussion about money," he said. "So it may behoove us to stay in the process." But what about that wait? "They are using it as a bar- gaining chip," van Halem said. "They're saying, you only have 10 claims assigned to an ALJ, and 790 are sitting there and will be for a long time. That's frustrating. The settlements that I've been involved in have not been great experiences." Stark also feels like the settle- ment offers are not in good faith, particularly when CMS has said, in its litigation with the American Hospital Association, that it can't clear the backlog at the ALJ by 2021 as ordered, because it needs to look at each claim and verify medical necessity. "I don't know if it's a really great way to avoid accountability," she said, "and none of it fixes the underlying problem of trying to figure out how not to get claims to the ALJ in the first place." hme stakeholders are slowly but surely getting the word out about issues with the program. "I think there's enough informa- tion going around CMS with the access to care study and some of the other stuff, that I can't imagine CMS is actively entertaining adding more to it, at least not for 2019," she said. Of greater concern among Med- PAC's recommendations: requiring suppliers to be participating sup- pliers, thus limiting their ability to charge the beneficiary when bill- ing unassigned. That would be a major problem in non-bid areas, says Bachenheimer. "They are talking about pro- tecting beneficiaries and limit- ing the amount you can charge them," she said. "But, in the non- bid areas, that's how a lot of peo- ple are surviving. It's not finan- cially feasible." hme m ED p A c c o n t i n u e d f r o m pa g e 3 "I wish we could afford to use it on oxygen," said Katy Collins, the lead RT at Archbold Home Care in Thomasville, Ga. For these reasons, the ramp up in using remote patient monitoring for oxygen patients will likely be a protracted one. In fact, only 15% of respondents who don't current- ly use remote patient monitoring plan to in the next year, according to the poll. "Remote patient monitoring for oxygen is great but will be a slow implementation, as we would not replace our existing equipment just to add the technology, and then only if the price is competitive," Wonsick added. But respondents who are lever- aging connected technology from the likes of O2 Concepts, Invacare and CAIR e to remotely monitor their oxygen patients are saying it pays off. "It has reduced service calls, assisted with reimbursement from HMO administrators and reduced shrinkage due to theft or moving after death," wrote one respondent. "Currently, one-fifth of our patients are monitored." hme 0xy GEN m ONITORING LAGS c o n t i n u e d f r o m pa g e 3

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