HME News

APR 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 ews.com / april 2018 / hme N ews VGM's Respiratory program provides the tools and resources you need. Profitability Calculator Policy and Procedures Manuals Billing Tips Patient Education Materials Webinars and FREE CEUs Vendor Programs Incremental Growth Products Listserv Community Forms All NEW program - Build a more robust respiratory offering. To learn more, contact Dave Lyman, BA, RRT-SDS VP of VGM Respiratory 20+ years' experience Join VGM Respiratory today! www.vgm.com/respiratory "For the 2018 filing year, we should see a decrease to our taxes, in part due to the 20% deduction that will be allowed," said one respondent. "This will help offset the low reimbursement we continue to deal with." Respondents also credited tax reform for everything from salary increases to cash sale increases. "The overall optimism in the economy has made it easier to sell the bigger-ticket items," wrote one respondent. But for the majority of respondents, it's hard to see past the destruction caused by the bid program, something that could con- tinue under Trump. A recently released HHS budget for fiscal year 2019 proposes imple- menting an actual bid process in rural areas, a move the agency believes would save billions. "If they do not provide relief with the IFR or H.R. 4229, there will be a drastic loss of rural providers," wrote one respondent. "I see where HHS now wants to conduct com- petitive bidding in rural areas—what a joke. As if there is $6.5 billion more to save. o ur government is bent on destroying DM e busi- nesses and is doing a good job of that." Indeed, there may be some disappoint- ment among the 64% of respondents to an HM e Newspoll back in September 2016 who said they would vote for Trump, believing he would bring a business perspective to health care. hme TR ump c o n t i n u e d f r o m pa g e 3 (prescribed amounts of stationary oxygen for daytime use while at rest and night- time use differ and the average of the two amounts is greater than 4 liters per minute). Second, by modifying existing modifi- ers Q e , QF and QG, CMS has instructed that patients must now need more than 4 liters of oxygen per minute "at rest," not at exertion, to qualify for a high-volume adjustment that increases reimbursement from $70.74 per month to about $106 per month. HHS says these changes will result in $6.5 billion in savings over 10 years. "I am aghast that there's belief in the budget that there's $6.5 billion that can be take out of the DM e benefit," said Tom Ryan, president and C eo of AAHomecare. "We've already stripped the benefit and I don't think there's any more savings to be had." HHS says in the event that less than two suppliers submit bids in a rural area, CMS will use a reference price from other, simi- lar rural areas. In many of those areas, there could very well be fewer than two suppli- ers bidding. At a well-attended Capitol Hill briefing Feb. 14, provider Mike Calcaterra, Northern Zone vice president for Norco and the Montana State Chair for Big Sky AM e S, detailed how 20% of HM e provid- ers in Montana and 37% of providers in Idaho have closed their doors since 2013. "There's a real access issue," said Ryan. "We have a solution. We need to get the interim final rule moved forward and we need support for H.R. 4229." o ther DM e -related provisions in the HHS budget include: e liminating the face-to-face require- ment; testing whether using a benefit manager will result in fewer improper pay- ments and lower utilization; and expand- ing prior authorizations to orthotics and prosthetics. hme BI dd ING c o n t i n u e d f r o m pa g e 1 "This will exclude patients who previ- ously qualified for high-volume adjust- ments," Stark said. The reimbursement difference for a patient considered standard volume and high volume is about $20 to $30, a change that may be hardly worth the savings when you consider the upheaval to the documen- tation process and the possible threats to patients, Stark says. "This is just one more blow," she said. "These high-liter-flow patients are the most expensive patients to take care of, and providers aren't going to be paid nearly enough." hme O xy GEN c o n t i n u e d f r o m pa g e 3 Texas providers beat back rate cuts A u STIN, Texas – Providers in Texas have staved off reimbursement cuts proposed by Superior HealthPlan, a managed care company that oversees part of the state's Medicaid program. Providers were noti- fied in February that Superior was reduc- ing rates for certain product categories from 85% of Texas Medicaid rates to 60%, with a few providers receiving a reduction of 65% to 70%, effective May 1. Providers were given 30 days to accept or reject the plan. In response, VGM Group organized a conference call with providers, encourag- ing them to voice their concerns with Supe- rior, the Texas Health and Human Services Commission and state lawmakers. "Provid- ers stepped up and answered the call for action by engaging with public officials to display their opposition to these egregious cuts," said Collin Brecher of VGM Govern- ment Relations. "While states are looking to trim their budgets, these proposed cuts are going to continue to appear, and pro- viders in all states must remain proactive by building relationships at the state level to prevent these types of harmful cuts from being implemented." In an online notifica- tion on Feb. 26, Superior stated it was sus- pending the reimbursement changes at this time. hme medtrade booth 513

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