HME News

AUG 2019

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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Vendors 20 WWW.HMENEWS.COM / AUGUST 2019 / HME NEWS BOC: 'AOs are vigilant in looking for fraud' BY LIZ BEAULIEU, Editor OWINGS MILLS, Md. – How much of a role do accrediting organizations play in helping to prevent and eliminate fraud, waste and abuse? "Throughout the accreditation process, AOs are vigilant in looking for fraud, waste and abuse," said Matthew Gruskin, the cre- dentialing director for the Board of Certifi- cation/Accreditation (BOC). "CMS requires AOs to conduct site surveys to check for com- pliance with CMS Quality and Supplier Stan- dards. Many of these standards are designed to help prevent fraud." Here's what else Gruskin had to say: HME NEWS: Preventing and eliminating fraud was one of the reasons CMS began requiring accreditation to begin with, right? Matthew Gruskin: CMS began requiring accreditation to ensure all suppliers comply with CMS Quality Standards to receive Medi- care Part B payments and to retain a supplier billing number. Requiring compliance with these standards also helps prevent fraud. HME: What parts of the accreditation process help to keep fraud at bay? Gruskin: The entire accreditation process is designed to ensure compliance with CMS standards. If fraud, waste and abuse are identi- fied during the accreditation process, the AO immediately reports it to the National Sup- plier Clearinghouse and possibly other enti- ties, as well. The NSC follows up on concerns involving suspected fraud. HME: One would think that the required on- site surveys would be one of the more effective ways to determine fraud. Gruskin: Every supplier has an unsched- uled initial survey. The AO also conducts an unscheduled follow-up survey if a concern arises. Site surveyors thoroughly assess com- pliance with required standards and regula- tions. HME: What happens when an AO suspects fraud? Gruskin: Every AO reports suspicious activ- ity as part of their relationship with NSC and CMS. For example, if a business operates for months with no patient charts, if all patient charts come from the same physician, or if all charts reflect orders for the same prod- ucts, an AO would report these findings to the NSC. HME THE FUTURE C O N T I N U E D F R O M PA G E 1 9 there. HME: It's a big deal to change the name of a major and shake up the curriculum. What does it say that the university is doing this? Racine: It means the university wants to grow the program and it wants to pre- pare these students to best succeed. In the next 10 to 15 years, this space—the homecare and post-acute care space— is going to be booming, literally, with aging baby boomers. You have to pre- pare students to take on these chal- lenges when they enter the workplace. HME: How does this benefit the HME industry? Racine: It bodes well for our industry and the patients we serve. Anytime you have a new generation of people coming into an industry with fresh perspectives and ideas is always a good thing. These students could end up in business, or maybe they will end up in government. The most important thing is that we educate them to understand the indus- try from all angles so that the students and the industry has the best chance of success now and in the future. HME VIP MEDICAL C O N T I N U E D F R O M PA G E 1 9 HME industry for more than 33 years, many of them running her own billing and con- sulting company. But due to an illness, she sold the company, reduced her workload and skipped the industry's speaking circuit for several years. She's now back at it. VIP will combine Wikinson-Bunch's ser- vices with its existing products and services, including product fulfillment and a propri- etary electronic management records (EMR) system. "You have CRM software and you have EHR software, and our EMR system tries to be somewhere in the middle and use the features of both," said Michael Kochen, part- ner and COO and head of VIP's technology division. "There's a need for it—there's a general need for technology disruption in this industry." VIP's fuller package of products and services will help set apart the company, Kochen says. "They've just sold you software; we're going to be interactive," he said. "It's not just Jane's consulting—I also do technology consult- ing. We're going to help you become more successful." VIP allows customers to select the prod- ucts and services they want, much like they'd select toppings for a pizza, Kochen said. "If you just want the billing module or want consulting for bidding or want help with a HIPAA audit—you can pick and choose what you want," Kochen said. "Every case is different. We don't want to be cookie cutter." Wilkinson-Bunch says she's happy to be back and happy to be partnering with a com- pany like VIP that will help bring her ser- vices full circle. "Consulting's great, but if you're not able to then help them with implementation, it's not so great," she said. "I'd often go back to clients and say, 'You haven't implemented anything that I suggested.' Now I can offer them a complete solution." HME ELYRIA, Ohio – Invacare has provided an update on its "transformation and growth plan," including an overhaul of its North America sales organization. The company has appointed Joost Belt- man vice president of sales and marketing for North America, and Keith Brantly direc- tor of CRT sales. "These are exciting key roles for us to have filled with strong talent," said Mat- thew Monaghan, chairman, president and CEO. Beltman joined Invacare in 2008 as country manager for the Netherlands and has held roles of increasing responsibility since then, most recently managing direc- tor, Benelux (Belgium, Netherland, Luxem- bourg) and Italy regions. Brantly re-joins Invacare from Amoena USA, where he was vice president of sales. From 2016-18, he served as national accounts direc- tor and regional sales director for Invacare. I n v a c a re h a s a l s o announced a workforce reduction of about 75 associates in North America and Europe. Once the reduction is completed, it expects to generate about $6.4 million in annual- ized pre-tax savings, $3.3 million in Europe and the remainder in North America. "While decisions that affect our work- force are never easy, it is important that we make long-term focused decisions and take actions that streamline our business to optimize our cost structure," Monaghan said. "Actions like these will enable us to successfully execute our transformation strategy and increase shareholder value." Additionally, Invacare has launched several new products, including a new line of active manual wheelchairs under the Kuschall brand, and a power add-on that allows electric drive for active manual wheelchair users called SMOOV one. Both new products are available in Europe and the company seeks clearance to also dis- tribute them in other regions. "We have an incredibly full pipeline of new products on the horizon, which will help us achieve our long-term financial goals," Monaghan said. HME Invacare fills 'key roles' for NA Company also announces workforce reduction, product launches M. Monaghan ACCREDITATION AND FRAUD C O N T I N U E D F R O M PA G E 1 working with fraudulent lead-generation companies. "We're not the fraud police; we're the qual- ity police," said Sandra Canally, founder and president of The Compliance Team. "Our focus is on quality patient care; it's not on a forensic audit of their billing." CMS has required that providers get accred- ited for more than a decade. It's a process that, generally, involves meeting quality standards around business (administration, financial management, HR management, consumer services, performance management, product safety and information management) and ser- vice (intake, delivery and setup, training and instruction, and follow-up). Of course, in the process of determining whether or not a provider meets these stan- dards, AOs can uncover fraud. "Typically, it stems from patient com- plaints," she said. "Then you can deny or revoke accreditation based on a pattern of unresolved patient complaints." One such scenario that might raise a red flag: An AO might ask a provider to show them a prescription for a piece of equip- ment and the provider might say, "We got it from a lead-generation company," which is legal, but the AO might subsequently find out from patient complaints that the equip- ment wasn't wanted and there's no process for returning it. "That's a violation of the standards," said Tim Safley, program director of DMEPOS, sleep and pharmacy for ACHC, "and we'd report it." AOs also conduct on-site surveys every three years, but in "Operation Brace Yourself," like in other fraud schemes, companies that want to run afoul of the law will find "work- arounds." They might, for example, buy a provider with a Medicare number—one that may not have to renew their accreditation for another few years—and then change its busi- ness model. "They're aware and they'll find the little niches," Safley said. AOs will always investigate when they see patterns that may be troubling or suspi- cious—Canally calls it "pulling the thread"— but it's not their job to bring up what they may suspect as fraud with a provider. "We report it to CMS so it can be reported to the Office of Inspector General," she said. "Then it's up to them to take action. It's not our jurisdiction." HME Philips sleep headband takes flight at NASA AMSTERDAM, the Netherlands – The Smart- Sleep Deep Sleep Headband from Royal Philips will be used in research funded by the Translational Research Institute for Space Health (TRISH), a virtual insti- tute empowered by the NASA Human Re- search Program, for two studies evaluating the relationship between sleep and cogni- tive performance for behavioral health. The two-year initiative will use the headband to determine if sleep can be improved during deep space exploration by using a vari- ety of auditory stimulation protocols and, thereby, maximizing cognitive function. TRISH, in collaboration with researchers from the University of Wisconsin-Madison and the Perelman School of Medicine at the University of Pennsylvania, has begun the following studies: Optimizing Auditory Stimulation to improve cognitive perfor- mance (24 subjects will use the headband at home for two months, performing a NA- SA-validated cognitive test battery daily) and Improving Efficiency and Restorative Quality of Sleep (a seven-day lab trial rep- licating the challenging sleep conditions experienced during spaceflight will study 12 subjects wearing the headband). Do AOs police fraud? It's not their main job, they say. See story page 1

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