HME News

AUG 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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■ The court's acknowledgement of broken appeals system sends strong message, says Wayne van Halem. See story this page. CMS upends competitive bidding . . . . . . . . . . . . . . . . . . . . 1 Newspoll: Providers reconsider credit card policies . . . . . 3 Q&A: Jeff Baird on Stark Law . . . . . . . . . . . . . . . . . . . . . . . . 3 CMS's Verma says bid structure 'unsustainable' . . . . . . . . 4 News Briefs CMS to allow use of IFR rates WASHINGTON – CMS has agreed that states can process claims using the higher fee schedule amounts for claims in rural areas from June 1, 2018, through Dec. 16, 2018, according to a bulletin from AAHomecare. Previously, the agency had said that any fee schedule adjustments would not im- pact 21st Century Cures Act reconciliation, as they would be using the Jan. 1, 2018, rates. The agency also agreed that states that are not simply basing their rates on Medicare rates can present their utilization for reconciliation on area-of-service and for dates from Jan. 1, 2018, through May 31, 2018, and for June 1, 2018, through Dec. 31, 2018. CMS will then use the high- er rates for the rural areas in the reconcili- ation process. Idaho providers meet with representative's representative POCATELLO, Idaho – Maag's Prescription and Medical Supply and Big Sky AMES hosted Josh Sorenson, the field director for Rep. Michael Simpson, R-Idaho, recently. Meeting attendees talked about rural access issues in southeast Idaho. Simpson, who sits on the House Appropriations Committee, has not signed onto H.R. 4229, which would extend a retroactive delay of a second round of re- imbursement cuts and address the oxygen "double dip," or H.R. 3730, which would stop competitive bidding-related cuts for acces- sories for complex manual wheelchairs. The bills currently have 153 and 108 cosponsors, respectively. Who's top woman in HME industry? WATERLOO, Iowa – The nomination period for the 2018 HME Woman of the Year is open. Now in its third year, the award, sponsored by VGM, recognizes one woman in the in- dustry who has made increasingly signifi- cant contributions throughout her career to her company, community and the HME industry. Last year, 38 nominations were received, with nominations represent- ing providers, manufacturers, association execs and other professionals. Barbara Smith, CEO of Healthline Medical Equip- ment, took home the award at Medtrade in Atlanta last year. Nominations are due by Aug. 13 and can be submitted online. Calling all speakers: Medtrade Spring wants you LAS VEGAS – Medtrade Spring organiz- ers seek speakers and panelists for the 2019 show, scheduled for April 17-18 at the Mandalay Bay Convention Center. Submissions are sought on the following topics: business operations, legal issues, regulations and compliance, sales and marketing, executive leadership, Medicare updates, retail and cash sales, and stra- tegic planning. Deadline for submissions is Aug. 24. WWW . HMENEWS . C o M / augu S t 2018 / HME NEWS 3 By Liz Beau L ieu, e ditor WASHINGTON – A more relaxed Stark Law could be a double-edged sword for HME providers, says healthcare attorney Jeff Baird. In a request for information pub- lished in the Federal Register on June 25, the Department of Health and Human Services asks for feedback on "how to address any undue regulatory impact and burden of the physician self- referral law." Here's what Baird, chairperson of The Health Care Group at Amarillo, Texas-based Brown & Fortunato, had to say about how HHS's decision could impact the HME industry. HME n E ws: HHS says it sees some aspects of the Stark Law as "a potential barrier to coordinated By T. F L aher T y, Managing e ditor F E w ER THA n half (36%) of providers say they keep a credit card on file for customers but that may be changing, say respondents to a recent HME n ewspoll. "A Plus Medical Equip- ment has not pursued credit cards on file in the past," said Jerry Roberts in Cape Girardeau, Mo. "Given the number of patients with past due balances, this is under review." In fact, 60% of the total amount owed by patients is never collected, and 30% of all patients have a past due balance of 60 or more days, according to Brightree. Many respondents cited security as their reason not to keep the information on file. "It's for the customer's safe- ty that we do not keep them on file," said Rachel w ard of AlternaCare Home Medical in Great Bend, Kan. "If a cus- tomer wants to call in a num- ber over the phone, we will do a payment that way and then we shred that information." Other respondents fear losing customers. " w e have actually had sev- eral patients transfer from other suppliers to us as a result of other suppliers implement- ing this policy," said one poll respondent. "It's one of the only things holding me back By Liz Beau L ieu, e ditor DALLAS – A U.S. District Court's recent opinion prohibiting CMS from recouping alleged over- payments from a provider going through the appeals process until after the administrative law judge level sends a strong message, industry stakeholders say. As part of the June 4 opinion, Judge Ed Kinkeade of the U.S. District Court for the n orthern District of Texas agreed to issue a temporary restraining order against CMS, the latest development in Family Rehabilita- tion, Inc. vs. Azar. "The system, which is supposed to offer a fair Court agrees broken appeals system unfair heard at heartland A more relaxed Stark Law? care . " What's the link between the law and coordinated care? Jeff Baird: The whole healthcare system is heading toward coordi- nated care, where providers must show third-party payers they're producing good outcomes. Third-party payers, whether it's the government or a commer- cial insurer, can't afford to con- tinue paying reimbursement in silos, where you have Provider A doing their thing and doing a good job but they're not coor- dinating with Provider B, who's not coordinating with Provid- er C. You have all this money going to different providers and they're not coordinating with each other, so it's not very effi- cient. w here the rub comes in is, when providers try to work together to increase efficiency, their attorneys tell them, " w ell, we can do that but there's some risk under Stark, if there is a financial arrangement." So it has had a chilling effect. HME: What's an example of an existing exception under the Stark Law? Baird: The In- Office Ancillary Services excep- tion says if a physician owns 100% of an ancil- lary services pro- vider, such as an ambulatory sur- gical center, and if he is super- vising it, the physician can refer patients to the provider because Engage employees, leverage growing demand Providers rethinking credit card policies C R E D I T c a r d s s e e pa g e 4 A P P E A L S s y s t e m s e e pa g e 4 S TA R k l a w s e e pa g e 8 By Theresa F L aher T y, Managing e ditor WATERLOO, Iowa – w hether it's medical supplies or a hot dog stand, if you want to build a world-class company, your employees need to provide exemplary service, said keynote speaker John DiJulius at the Heartland Con- ference in June. "Price is irrelevant," said DiJulius, author of several books on customer service and president of The DiJulius Group, a consul- tant to companies like Starbucks, Chick-fil-a, and The Ritz-Carlton. "(Customers want) compassion and empathy." That means empowering your front-line employees, not stifling them with restrictive policy, he said. That message was a recurring theme at the conference, which featured more than 70 exhibitors and a full slate of sessions covering 10 tracks, including a new executive track. The event drew more than 1,000 attendees, including 76 first-timers. Building on advice from DiJulius, keynote speaker Jared Johnson told attendees they need to employ the "pay people to think'' philosophy. H E A R T L A N D s e e pa g e 8 H E artland Conf E r E n CE keynote speaker John DiJulius tells attendees to empower front-line employees . Ross Burris Jeff Baird appeals process for providers, has been broken for some time," said w ayne van Halem, president of The van Halem Group. "The fact that it has been acknowledged now is very important." The district court in October 2017 "reluctant- ly dismissed" Family Rehab's initial request for a temporary restraining order for lack of jurisdiction, prompting the home health company to appeal to the U.S. Court of Appeals for the 5th Circuit. The circuit court in March of this year clarified relevant case law and kicked it back to the district court, prompting the recent opinion. At issue in the case is a requirement that the ALJ hear cases and issue decisions within 90 days—a timeframe that has ballooned to multiple years due to a massive backlog at the third level of appeals. "Many providers can't afford to refund the money and wait four years for a hearing," van Halem said. " w e have many clients whose cases are being Opinion pokes holes in CMS's 'favorite defense,' says attorney Ross Burris

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