HME News

OCT 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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New Products hme news / october 2018 / 29 J&L medica L c o n t i n u e d f r o m pa g e 1 4 hasn't been without hiccups, however: In 2016, it agreed to pay $600,000 to settle allegations that it violated state and federal regulations by using unlicensed technicians to set up CPAP and Bi-level machines—a common practice in the industry, Loyer said at the time. hme association. "We also talked about the 21st Century Cures Act and the intent of Congress, which is that the relief would be more broad. For all those reasons, I feel optimistic we can get there." AAHomecare also recommends that CMS establish rates in the former bid areas at the current SPA rates but provide an increase to those rates by all the CPI-U increases from 2013-18. With AAHomecare's comments now sub- mitted, the race is on to educate lawmakers. "It's complicated and there are not a lot of details," said Cara Bachenheimer, chair of the government affairs practice at Brown & For- tunato. "We need to educate our allies, staff and leadership of the committees of jurisdic- tion. Hopefully, they can echo similar con- cerns and make similar recommendations, as well. That's really the goal." Stakeholders have been laying the ground- work for broader relief all along, says VGM's John Gallagher, who, along with a group of providers, met with Rep. Cathy McMorris Rodgers, R-Wash., in August, and planned to meet with Rep. Greg Walden, R-Ore., chair- man of the Committee on Energy and Com- merce. "McMorris Rodgers wants to sit down with CMS and really go over the impact of the pro- gram and possible regulatory fixes," said Gal- lagher, vice president of government relations. "Along with the recent letter from West Vir- ginia—we are trying to get similar letters from Iowa, Montana and hopefully Kentucky—if we can get those raising questions, that's what we want to happen." hme he saw several signs of growing pains, includ- ing a request for a DME Information Form, or DIF, even though those aren't required for wheelchairs, just enteral nutrition and pumps. "I think they've started to ramp up already, and we're seeing some odd replies and requests for additional documentation," said Szmal, founder of The Mobility Consultants. "I think the people they're training—it's not any fault of theirs, they're just new to the policies and the nuances to them." What these growing pains mean is a lon- ger turnaround time for approvals for prior authorization requests, Szmal says. "We call and explain, and we ask them to reverse their decision," he said. "They say, 'We have to look into it,' and that takes two weeks." At least this might be a sign that CMS's contractors are ramping up staffing to meet the needs of an expanded prior authoriza- tion program, something that has been a top concern of stakeholder Don Clayback going into Sept. 1. "(The contractors) are taking on new vol- and providing aids to daily living. "Most are doing home assessments for oxygen safety, so they are familiar with the process," she said. "Extending the services to home modifications makes perfect sense – providers already have relationships with industry vendors, referral sources, clients and their families." Key drivers Harper says the demand for accessibility ser- vices has created a ready customer base, but cautions HME providers interested in enter- ing the business not to tread too lightly. "I think to be truly successful in HME, you need to be 'hands on,'" she said. "It's not a pizza franchise where you can hire a group of students. You need to be ready to listen to each client's needs, know your product and then know how to work with site considerations. We've seen great husband- and-wife teams where they can bring all those skills together to get started and generate success quickly. You need a wide variety of skills." Echoing that point, Lawrence maintains that "the best way to get into the business is to have a great team set in place so you can showcase the work. It's important to have skilled employees that understand the concept of producing quality work." Taking and showing photos of each job shows prospective customers the kinds of modifications that can be done to their homes, while home evaluations can give them specifics about the improvements, he said. "There are many needs to be taken into consideration, such as what products from A to Z need to be looked at in order to achieve bid comments c o n t i n u e d f r o m pa g e 1 ume, and they need to keep staffing in mind," said Clayback, executive director of NCART. "CMS has a system that's working, so that's the only caveat." The system is working, but it's still defi- cient in one important way, Toscano says: Prior authorization approvals don't cover the accessories that are submitted along with bases. In the previous Advanced Determina- tion of Medicare Coverage or ADMC process, they were. "There's still a void where accessories are concerned," she said. "I'm not sure why (they won't budge on accessories). Maybe because instead of looking at one LCD, you'd have to look at three or four LCDs and NCDs and policy articles, and they're thinking about the time reviewers have to spend on this." To prevent a provider from providing accessories only to have them denied down the road, Toscano says she's dotting her Is and crossing her Ts before submitting them with a base for prior authorization approval. "We're trying to prevent everything we can on the front end," she said. "We don't put it out to begin with unless we're certain." hme accessibi L ity c o n t i n u e d f r o m pa g e 2 2 Prior auth P rogram ex P ands c o n t i n u e d f r o m pa g e 1 Periodicals postage paid at Yarmouth, ME and additional mailing office. HME News (ISSN 10913823) is published monthly by United Publications, Inc., 106 Lafayette St., PO Box 998, Yarmouth, ME 04096; 207-846-0600. Publisher assumes no responsibility for unsolicited material or prices quoted in the magazine. Contributors are responsible for proprietary classified information. ©2018 by United Publications. All rights reserved. Reproduction, in whole or in part, without written permission of the publisher is expressly prohibited. Reprints may be obtained from The YGS Group at 717-505-9701, ext. 100. Back issues, when available, cost $7 each within the past 12 months, $12 each prior to the past 12 months. Back issue orders must be paid in advance either by check or charged to American Express, Visa, or Master Card. HME News is distributed without charge in North America to qualified home medical equipment providers. Paid print subscriptions to those not qualified cost $65 annually to the U.S. and Canada and $150 to all other countries. All payments must be made in U.S. funds drawn on a U.S. bank. For subscriber services, including subscription information, please call 800-869-6882. POSTMASTER: Send address changes to HME News, PO Box 1888, Cedar Rapids, IA 52406-1888. J oey graham c o n t i n u e d f r o m pa g e 2 3 There's no standardized platform. hme : Make the case for why KPIs should be a big part of any provider's business. Graham: Because otherwise, how do you know what you're doing, whether your com- pany's performance is acceptable or unaccept- able? It's like driving a bus forward, but you can't turn around and you have no idea where you've been. hme : Are certain KPIs more important? Graham: Three of the top KPIs are 90-plus AR percentage, or the accounts receivable older than 90 days; payment rate, or what percentage of billed revenue comes back as payments; and hold days, or how many days of revenue are tied up in your hold, whether it's because you're waiting for prescription approval, a prior authorization hold, or a manual hold for some other reason. hme : What are some of the logistics around KPIs? Graham: There are eight key metrics that we talk about. We break them down, then talk about where the data come from, how you calculate KPI, and what some standard indus- try benchmarks are. For example, 90-plus AR: How do calculate it? What can you do to improve? How do you prioritize your team's workload? hme : If attendees take away one thing from your session, what should it be? G r a h a m : They should start look- ing at their KPIs right away—optimal- ly, on a weekly basis, but monthly at a minimum. hme Joey Graham g eneral m anager, p rochant Tuesday, Oct. 16 2:45 pm to 3:45 pm Session: "Key p eformance i ndicators for your dme r evenue c ycle" Contact: what the patient wants from the project," Lawrence said. Campbell adds that dealing with prospective clients can be a delicate psychological process because they are undergoing a traumatic experience with their health. "Most people want to stay in their homes, but those homes don't support a safe environment for aging in place and most don't have a plan for it," she said. "I can't count how many times I've heard someone say 'Yes, I know I need to do that, but I'm not ready yet.' Unfortunately, home modification requires money and time, which in turn creates stress and anxiety for patients and their families. But it's preventable with planning and preparation." Find a F ocus Vision and focus are an integral part of any home accessibility project and it requires con- tractors to work closely with clients to get everyone on the same page, Harper said. "Cost questions inevitably come up, but education about the cost of alternatives is often helpful," she said. "That might include costs associated with moving, staying in a senior living community or the cost of a fall if nothing is done. A fall is not only an economic cost, but is also a tremendous setback for the client's health." The scope of home accessibility services is wide and can present a challenge for small- to medium-sized HME companies to manage, Harper said. "Bathroom renovations and elevator installations may require more expertise or licensing, so you may not want to take that on unless you feel confident with it," she said. "It is best to stick with what you are trained to do. Clients are trusting us with their safety, so you need to know your stuff." hme Dalton m edical Corp. Dual Purpose Wheelchair The Dual Purpose Chair is designed to solve the dual purpose of being a standard wheelchair and Transport Wheelchair. The product is ultra light- weight and is made of aluminum frame. To accom- modate the dual nature of the wheelchair, it comes with two sets of brakes; one serves as the brakes for the standard wheelchair and the other serves for the transport wheelchair. Sunrise m edical Quickie Q700 M Sedeo Ergo The Quickie Q700 M Sedeo Ergo is an advanced mid-wheel power wheelchair. Switch-It Remote seating app plays an important role in pressure management, and is compatible with Android and Apple devices. Deep contour back provides addi- tional support. Reliable SpiderTrac 2.0 suspension with patented anti-pitch system delivers excellent outdoor performance and smooth curb climbing. Compact turning radius. Sigvaris Compreflex Reduce This compression system is for use during the decongestive phase of lymphedema therapy. It is designed to be periodically modified during treat- ment such that the same garment can be worn throughout the course of therapy. Comfortable, easy to don and doff, inelastic wrap that promotes adherence and improved quality of life for patients with medically complex edema. Available in black and beige, and includes individual thigh, knee, below knee and boot components that can be used together for total leg coverage. Responsive Respiratory Pediatric Regulator Responsive Respiratory's pediatric regulator has been upgraded to include a new 1/64th flow setting to its 0-3 LPM flows. Available with a CGA 870 or CGA 540 connection with a barb or DISS outlets. The regula- tor with engraved conversion table benefits providers by offering a versatile range of low flows to meet the needs of all pediatric patients while streamlining inven- tory, thus eliminating the need to carry duplicate prod- uct to cover decimal and fraction flow settings. Drive DeVilbiss h ealthcare Competitor II Hi/Lo Height Adjustable Bed The Competitor II bed includes a pendant lock-out feature that helps prevent accidental actuation of head or foot deck adjustment when in the locked position. The manual hi/lo bed is equipped with a positive fit hexagonal crank connection for easy raising and lowering. The bed is furnished with a slate deck for added strength and no-sage mattress support, ultra-light head and foot frames. Supports up to 450 pounds. Joey Graham

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