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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Page 4 of 32

News Briefs VGM rolls out bid-related tools... WATERLOO, Iowa – The VGM Group has re- leased an interactive tool that allows provid- ers to assess what areas CMS has deemed bid, non-rural, rural and non-contiguous. The tool provides maps for all 50 states, allowing providers to determine what area a zip code falls under. "With the proposed changes coming down from CMS excluding relief from the non-bid areas and opening up competi- tive bidding areas to any willing provider, it is important that providers understand what they will be reimbursed and where those lines fall on a map," said John Gallagher, vice president of government relations. ...tallies costs by region WATERLOO, Iowa – The VGM Group has released the results of a "Delivery Cost Survey" that puts into perspective how costly it is for HME providers to provide patients with the necessary equipment. In New England, for example, providers report that it costs them $22.43 in vehicle costs per delivery and $18 in labor costs per hour, according to the survey. When you take into account the 23.33 miles from business to home and the 31.67 minutes it takes for in-home set up, that's an average total delivery cost of $67, the report says. Study details increased Part A costs WATERLOO, Iowa – A study sponsored by The VGM Group shows the cost shift that is happening as a result of reduced access to DME for Medicare beneficiaries. The study by Leitten Consulting shows that: Fall-related injuries due to failure to provide needed mobility equipment results in a cost shift of between $4,705 and $5,029; and OSA-related complications due to failure to provide CPAP therapy results in cost shift of $1,631. "When this happens, Medicare incurs substantial increased Part A costs to treat medical complications caused by not having the needed DME," Brian Leitten writes in the study. GAO sides with C2C on QIC contract WASHINGTON – The Government Accountabil- ity Office agrees that CMS failed to prop- erly assess "potential organizational conflict" when the agency awarded Maximus the DMEPOS QIC contract. The GAO's decision comes after C2C Solutions, the current QIC contractor, protested the award. The GAO's decision sustains C2C's protest. "Protest that the agency failed to evaluate a potential impaired objectivity organizational conflict of interest is sustained where the awardee's wholly-owned subsidiary would review de- cisions on appeal from the parent compa- ny's own claims decisions, and the agency did not meaningfully consider whether this structure created an impaired objectivity organizational conflict of interest," the GAO stated. ■ Stakeholders have been laying the groundwork for broader bid relief, says VGM's John Gallagher. See story page 1. Newspoll: Expect shifts to Medicare provider base. . . . . . 4 Stark, Baird talk post-Jan. 1 world . . . . . . . . . . . . . . . . . . . 4 Q&A: Wayne van Halem on 'aggressive' UPICs . . . . . . . . . 4 State news: Minnesota, Illinois . . . . . . . . . . . . . . . . . . . . . 6,8 4 h M e new S / OC t O ber 2018 / www.h M enew S . COM By Liz Beau L ieu, e ditor T he majority of non- contract suppliers who responded to a recent hme Newspoll (60%) say they won't try to pick up m edicare business starting j an. 1, 2019. i n a recent proposed rule, C m S outlined its plans to implement an "any willing provider" provision when the current competitive bidding contracts expire, allowing any m edicare-enrolled provider to serve beneficiaries while it overhauls the program. " i will choose to not service m edicare patients because m edicare's reimbursement By Liz Beau L ieu, e ditor ATLANTA – i t's time for hme providers to reac- quaint themselves with the Unified Program i ntegrity Contractors, or UP i Cs, says Wayne van h alem. C m S announced plans to create this new program integrity contractor years ago, but after numerous protests and transi- tions, the UP i Cs are only now "fully operational," says van h alem, presi- dent of t he van h alem Group. h ere's what he had to say about where the UP i Cs are looking first. HME N E ws: Who are the UPICs? Wayne van Halem: t here are three contrac- tors for five jurisdictions. a dvance m ed for j urisdiction 1 ( m idwest); Qlarant for j uris- dictions 2 (Western) and 3 (Southwest); and Safeguard Services for j urisdictions 4 (Southeast) and 5 (Northeast). HME: What kind of audits are they conducting? van Halem: t hey're doing both pre- and post-pay audits. We like to use the term audit, but they use the term investigation. t hey're doing fraud investigations. HME: Are they focusing on any spe- cific product categories right now? van Halem: t hey seem to be focused on orthotic braces, because there are a lot of issues going on there related to telehealth or lead generation, and the volume is high. We've also seen some audits involving vents. HME: So high volume can trigger these audits? van Halem: t hey're heavily using claim data analysis, so yes, they're looking for spikes in billing. But they're also basing their audits on complaints from patients and referrals from other contractors for companies, for exam- ple, that go through the t P e process and fail. HME: How do the UPICs compare to other auditors? Liz Beau L ieu, e ditor YARMOUTH, Maine – t he m edicare landscape could look very different on j an. 1, 2019, but industry watchers don't expect any knee-jerk reactions from hme providers. i n a recent proposed rule, C m S outlined its plans to implement an "any willing provider" provision when the current competitive bidding contracts expire on Dec. 31, allowing any m edicare-enrolled provider to serve beneficiaries while it overhauls the program. " t he guns will go off on j an. 1, but i don't expect anyone to lunge to make drastic changes," said a ndrea Stark, a reimbursement consultant for m iraVista. " t here are too many things providers need to be thinking about logistically." j eff Baird, chairman of t he h ealth Care Group at Brown & For- tunato, agrees, saying, while he expects more pro- viders to accept m edicare busi- ness post- j an. 1, he doesn't expect a "sea change," because they're "rooted in old habit." r e-edu CA t IO n O f referr A l SO ur C e S i f non-contract suppliers do decide to accept m edi- care business, they're going to have the tall task of reaching out to referral sources to let them know they can now send business their way, Stark says. " r eferral sources have been told for years now, Expect shifts to Medicare provider base, says poll van Halem: 'Aggressive' UPICs take over Stark, Baird on post-Jan. 1 WASHINGTON – t he average reduc- tion in payment rates in non- competitive bidding areas for five D me items with the highest expenditures in 2016 was 46%, according to a new report from the Government a ccountability o ffice. i n its review of the effects of reduced payment rates in non- bid areas, the G ao also found that: the number of suppliers furnishing rate-adjusted items in non-bid areas in 2016 decreased 8% compared to 2015; and ben- eficiary utilization of rate-adjust- ed items in non-bid areas in 2016 showed little change compared to 2015. "G ao interviewed stakeholder groups that reported anecdotal examples of specific beneficiary access concerns they attribut- ed to the rate adjustments, but stakeholders could not provide evidence to substantiate that the access issues were widespread," the agency wrote in its report. "G ao 's findings are consistent with C m S's monitoring results, which indicate that there were no widespread effects on benefi- ciary access in the year after the adjusted rates went into effect." t he G ao continued: " h ow- ever, some effects may take lon- ger to appear, underscoring the importance of C m S's continued monitoring activities." i n a response to the report, t h e C o u n c i l f o r Q u a l i t y GAO reports on bid program rates are too low across the board," wrote one respon- dent. " i cannot afford to pro- vide equipment and service at the current rates. t here would need to be a significant increase in rates, e s p e c i a l l y f o r respiratory equip- ment, to make it feasible." t herein lies the rub for the major- ity of non-contract suppliers: t hey may be able to do busi- ness again with m edicare on j an. 1, but they have to do it at the current fee schedules in their area, which have been drastically reduced by the bid program. Still, for other non-contract suppliers, they say they see the "any willing provider" provi- sion as a means to an end: stay- ing in business. "Being able to again pro- vide m edicare beneficiaries with products and services could mean the difference between staying open or closing our doors," wrote Wil- liam Caldwell of City h ome m edical Supply in e lkton, m d. "We intend to begin an aggressive campaign to notify hospitals, doctors and area patients of our ability to provide services. a ll avenues to increase revenues to better serve the community will be considered and implemented." For contract suppliers, the majority (67%) say they will continue to do business with h M e NEWS POLL Jeff Baird p R O v I d E R s h i f t s e e pa g e 8 p O S T - J A N . 1 s e e pa g e 6 v A N h a l e m s e e pa g e 8 60% of non-contact suppliers, 33% of contract suppliers say they're out competitive bidding G A O r e p o r t s e e pa g e 6 W. van Halem Andrea Stark

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