HME News

FEB 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.hme N / february 2018 / hme N ews "We're reconsidering subcontracting going forward," the subcontractor said. " r eferrals are becoming more comfortable with the fact that some H m E companies can do some insurances but not others. We're also hop- ing, even though m edicare is a loss-leader, that we'll win more bids in the next round." a eroflow, which has continually sought to increase its base of subcontractors to help grow its business, says it has 10 people dedi- cated to handling processing and payments for that side of its business. b ut the company acknowledges that the system can be slow. "We find our largest challenge is receiv- ing proof of delivery in a timely manner," said r yan b ullock, cio . " t his often leads to delays in subcontractor payment." a t the end of the day, subcontrators say they're the glue, not contract suppliers, that's keeping the bid program together, for better or worse. " t his is why competitive bidding has suc- ceeded in the eyes of m edicare, because the local providers are always stepping in," said one subcontractor. hme subc O n TRA c T s c o n t i n u e d f r o m pa g e 3 I ns A nd O u T s c o n t i n u e d f r o m pa g e 3 base m edicaid reimbursement on m edi- care's fee schedule or competitive bid rates, or a lesser percentage thereof; or conduct a "robust comparison" using both rate and unit utilization data to cal- culate what would have been the aggre- gate reimbursement under m edicare for those same items to demonstrate that m edicaid reimbursement is less than the allowable amount. For the first option, states must submit a plan amendment no later than m arch 31, 2018, with an effective date no later than Jan. 1, 2018; for the second, or an alternative approach, they originally had to inform cm S by Dec. 31, 2017. i n a Jan. 4 letter, however, cm S backed off, stating: "States electing to submit an aggregate payment compari- son, or an alternative approach to com- pliance as mentioned earlier in this let- ter, will work with cm S to determine the best approach to calculate the FFP limit for their state using expenditures for the period of January 1, 2018, through December 31, 2018. cm S is in the pro- cess of obtaining the required o ffice of m anagement and b udget approval for these payment comparisons via the Paperwork r eduction a ct process. o nly after cm S obtains a valid omb control number will states be required to submit this information. a ssuming P ra approv- al, the first comparative analysis must be submitted to cm S by m arch 31, 2019." t he problem with the second option remains that state m edicaid directors don't have all the information they need to conduct a "robust comparison." t he Dec. 27 letter refers to a number of appendices with source data that were never provided. cm S has not even offi- cially published a list of affected H c P c S codes. "Without all of this, a state can't make to make up for that low reimbursement with additional volume, and subcon- tractors want to hold on to their referral sources, so here we are. Here's what b aird had to say about how these agreements should be set up. I N a perfect world "We have the contractor abc and the subcontractor X y Z. abc talks with the doctor; they get the order in; they make the decision as to whether or not the patient meets the medical necessity cri- teria. So abc is the one that goes through the mental process. t hen they call X y Z and say, ' o K, you need to take care of m rs. Smith,' and X y Z does the heavy lifting. t hey deliver equipment; they educate m rs. Smith and set her up; they handle repair and maintenance. abc then bills m edicare, gets paid and pays X y Z." I N real I ty "X y Z doesn't want to lose their referral sources for bid products and non-bid products, and doctors want one-stop shops. So the X y Zs look at the cbic website, see who the winners are and call them and say, 'We see that you have a con- tract for this cba ; i want to be your sub- contractor.' Here's the hook: t hey also say, ' i 'll send you all kinds of patients.' Doctors are loyal to X y Z, so they're going to con- tinue to refer to X y Z, and X y Z is going to send patients to abc ." h ere's where I t gets d I cey " t he cbic wants the referrals to go through abc , not X y Z. Well, the subcon- tractors fudge that a little bit and often referrals do flow through subcontractors to contract suppliers. i f the cbic deter- mines that, they might come in and say, don't do that." " t he other area that's a problem is if X y Z says to abc , 'Here's everything; just bill for it.' y ou can't do that. i f X y Z is doing everything, including the intake, and all abc is doing is submitting a claim, that's a sham. i t's critical that abc has skin in the game." hme Briefs ats oxygen study bolsters industry findings WA s HI n GTO n – A recent study from the American Thoracic Society correlates with the HME Patient Access Study sponsored by AAHomecare, the association says. Dobson DaVanzo & Associates has put to- gether a summary of how the ATS study, "Patient Perceptions of the Adequacy of Supplemental Oxygen Therapy: Results of the American Thoracic Society Nursing Assembly Oxygen Working Group Survey," reinforces findings of the patient access survey. In particular, both studies suggest that the financial pressure on the HME in- dustry is impacting the lifestyle of oxygen patients, especially Medicare beneficiaries. V gm rallies c ongress WATERLOO, Iowa – The government rela- tions team at Waterloo, Iowa-based VGM will soon introduce a new tool to bring its members breaking news. "We will be using a program called Rally Congress to allow providers to quickly and easily message their members of Congress and state gov- ernments," VGM stated in a recent bulletin. "This effective tool has resulted in many consistent supporters of the DMEPOS and CRT industries." m edical device tax goes back into effect WA s HI n GTO n – A 2.3% excise tax on medi- cal device manufacturers went back into effect on Jan. 1 after a two-year hiatus, according to news reports. The tax ini- tially went into effect in 2013 as a way to p ay for expanded health insurance under the Affordable Care Act. The $150 billion medical device industry, representing ev- erything from catheters to artificial joints, has fought the tax hard. an informed decision," Williard said. "Even with it, a little over two days is not enough time to analyze everything." While some states have chosen the first option—what cm S calls in the let- ter "the simplest way"—states like a la- bama have delayed making a decision until they receive additional information. a labama has run data and sent it to cm S for validation but has been told it won't hear back until after Jan. 1, said Leigh a nn m atthews, the man- ager at c omplete c are in Fort Payne, a la., and the president of the a labama Durable m edical Equip- ment a ssociation. "We have a good rela- tionship with m edicaid and they understand the potential access issues if they go forward with this," she said. "So they want to aggres- sively look at the data." While states where m edicaid programs are largely administered by managed care organizations are exempt from the provi- sion, stakeholders know mco s will be keeping a close eye on the changes to see how they play out in January and beyond. "Will they follow suit?" said Karyn Estrella, executive director of the Home m edical Equipment and Services a sso- ciation of n ew England. " o ur under- standing is it doesn't affect those plans, but when have mco s not followed m edicare?" aa Homecare is keeping tabs on each state's decision and has shared the letter with legal counsel, Williard says. "We plan to put together some type of strategy," she said. "We will continue to work, not only from a state perspec- tive but also from a legal perspective. We want to impact this any way we can." hme d EA d LI n E HA n G s OVER ME d I c AI d c o n t i n u e d f r o m pa g e 1 Laura Williard Don't get snowed by the competition Downloadable in two formats: Excel PDF Subscribe to the HME Databank and gain access to the most comprehensive database of Medicare data for the HME industry. • Determine your market share • Track competitors • Strategize for growth

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