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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News 4 WWW . HMENEWS . C o M / augu S t 2018 / HME NEWS Live at Home Pro is the complete digital solution for all your home assessment needs. • Track the progress of all your projects from one dashboard. • Add photos and measurements directly to the assessment. • Present product suggestions on-site • Keep your data safe with HIPAA- compliant security. • Generate professional proposals. • Get early access for a one-time fee of $96. Offer good until Oct. 31. Reach out to VGM Live at Home to learn more, become a member and get started! jessica.barber@vgm.com | 877-404-2442 Live at Home Pro Digital Tool Early Access Version for Live at Home Members Only By Theresa F L aher T y, Managing e ditor WASHINGTON – CMS Administrator Seema Verma says she wants to "modernize" the agency's long-standing competitive bidding program for DMEPOS by instituting mar- ket-oriented reforms. It's a major change in attitude for the agency, which has lauded competitive bid- ding and the savings it has created since the program was first implemented in 2011. "The current structure doesn't produce the best prices for patients and doesn't drive optimal performance by contractors, and it's simply not sustainable in the long term," Verma said during a press call on July 11, following the release of a proposed rule out- lining changes to the program. "In devel- oping today's rule, we worked with experts to leverage market principles that would support competition when contracts are re- competed under the revised bid program." One of the more significant changes in the proposed rule: Replacing median-based bidding with lead-item bidding to establish prices at the maximum winning bid. As an example of the new methodology, CMS's Verma: Current bid structure 'unsustainable' Verma said rather than soliciting bids for power wheelchairs and every accessory, CMS will accept bids only on power wheel- chairs. The agency will then set pricing for accessories using a scale based on the his- toric fee schedule amounts and on supplier data, she said. "This approach will streamline the bid- ding process, reduce the burden on sup- pliers and ensure that pricing is accurate," she said. " w e hope that this will bring more competition and vendors to the pro- cess and, ultimately, increase access for the beneficiaries." To allow time for the revised program to take effect—a process that could take any- where from 18 to 24 months, Verma said— the proposed rule would also temporarily extend the current reimbursement rates in bid areas, non-bid areas, and rural and non- contiguous areas, she said. Additionally, "beginning Jan. 1, 2019, and until new contracts are awarded, ben- eficiaries may receive DMEPOS items from any Medicare-enrolled supplier," the agen- cy stated in a press release that accompa- nied the proposed rule. HME assigned for hearings now that went out of business since the time we submitted them." That was the crux of Family Rehab's argu- ment. It argued the continued recoupment of the $7.5 million in alleged overpayments would force the company to shut down, caus- ing "irreparable injury." "Having already laid off most of its employees and limiting home healthcare to only eight of its previous 289 patients, Fam- ily Rehab will be forced to permanently close its doors," Kinkeade wrote in the opinion. The opinion pokes holes in CMS's "favorite defense," says Ross Burris, a healthcare law- yer for Polsinelli based in Atlanta. "They're famous for saying, 'You can't sue us because there are administrative reme- dies,'" he said. "But what the court is saying here is, 'Those remedies are non-existent.'" w hile the opinion has limitations, it does open the door for other providers to use the same argument, van Halem and Burris say. "If you're appealing and you believe your company is going to be in dire circumstanc- es under the recoupment—you're not just angry; you have an immediate chance of irreparable harm—you now have an option," Burris said. Elizabeth Hogue, a healthcare lawyer based in w ashington, D.C., agreed. "This case is definitely one for providers to watch," she said. HME APPEALS c o n t i n u e d f r o m pa g e 3 from trying to implement it myself." It's a chance some are willing to take. One respondent has just begun requiring credit card information for all patients without secondary insurance coverage. "It has really gone smoother than expected," said Lori Valentine of Memorial Medical Equipment in Springfield, Mo. "A handful of customers leave, but are not sure if they are changing providers yet." It's important to have policies in place, she added. "There is a release that is signed by the customer and kept on file," she said. "The policy does include a service fee of $35 if their card is denied. Once they provide a new payment form, the fee is revoked." w ith some patient groups, requiring credit information is a necessity. "I try to get them on CPAP clients," said one respondent. "They're the worst to pay the ongoing bills. You could take a rocket scientist and explain what the deductible is and they call with the first bill and ask why the insurance did not pay." n o need to split hairs, says one provider. "Policy: no card, no service," said w oody O' n eal of O' n eal Medical in Bir- mingham, Ala. HME CREDIT CARDS c o n t i n u e d f r o m pa g e 3

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