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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News 4 WWW.HMENEWS.COM / AUGUST 2019 / HME NEWS Submit the right bid for your business. Discover how to maximize your revenue with Round 2021 bid calculators. Use the bid calculator today! Visit Bid Smart! BY THERESA FLAHERTY, Managing Editor N EARLY TWO years after Perfor- mant Recovery announced it would perform an underpayment review for Group 3 power wheelchair options, providers are receiving refund checks, says Andrea Stark. Performant, the DMEPOS RAC, announced in May 2017 it would review wheelchair accessories, including seat- ing systems, and seat and back cushions furnished in conjunction with codes K0848–K0864 for the six-month peri- od of Jan. 1, 2016–June 30, 2016. The review was necessary because CMS was unable to make changes to its process- ing system to accommodate adjust- ments to the 2016 Medicare fee sched- ule amounts mandate. "They weren't able to be billed prop- erly, so they weren't paid appropriately and should have been subject to the higher amount," said Stark, a reim- bursement consultant with MiraVista. "I've had several clients get a check for a few thousand dollars, so that was pretty exciting." BE PREPARED TO MAKE YOUR CASE RACS, on the whole, aren't doing a lot of complex reviews these days, most likely due to the huge backlog at the administrative law judge level, where about half of all appeals are related to DME, says Kelly Grahovac, senior consul- tant for The van Halem Group. H o w e v e r, p ro v i d e r s who file appeals simply because they believe the judge will rubberstamp overturns will need to review those claims for accuracy and submit the appeal with a real argu- ment, she said. "The judges are getting much more training and have more understanding of policy than in the past," said Graho- vac. "That's not a bad thing—they can still make independent decisions, but they are making more informed deci- sions which requires the supplier to make a more articulated appeal." 'WORSE THAN RACS' While the volume of RAC audits has diminished, activity from UPIC con- tractors is rampant, says attorney Eliza- beth Hogue, especially in the West and Midwest. "They are suspending payments to providers altogether or they are putting the on 100% prepay review," she said. "In some respects, they are worse than the RACs. Unless you are a large agency that can withstand (not getting paid), it really just puts you of business." At least with the RACs, there is an appeals process to follow, says Hogue. Dealing with the UPIC—assuming you can even identify someone to talk to—is very difficult. "There's very little recourse with regard to payment suspensions," she said. "You an submit a rebuttal state- ment arguing that the suspension should be lifted, but that's a tough case to make." HME RACs cut checks, UPICs run roughshod AUDIT ROUND UP Kelly Grahovac Andrea Stark NEW BEDFORD, Mass. – Karyn Estrella, the pres- ident and CEO of Home Medical Equip- ment and Services Association of New England, has died at 61. She spent more than 20 years advocating for the HME industry. "She leaves behind an amazing record of accomplish- ment, and a legacy of leadership and service to the HME commu- nity," said AAHomec- are President and CEO Tom Ryan. "I am for- tunate to count myself among the many people in our industry who had the opportunity to work with her and see the passion, pro- fessionalism and generosity of spirit she brought on behalf of HOMES and in sup- port of her fellow HME leaders." HOMES announced in April that Estrella would take a medical leave after being diagnosed with pancreatic cancer. HME Industry loses leader Karyn Estrella

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