HME News

MAY 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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Medicare Market Marker The eSolutions Denial Tracker SOURCE: ESOLUTIONS The eSolutions Denial Tracker is an index of the percentage of Medicare and commercial claims rejected on a monthly basis. The most recent month's data repre- sents an analysis of approximately 1,379,374 Medicare claims and 4,129,557 commer- cial claims adjudicated between March 1, 2018, and March 31, 2018. The index is a categorized and weighted analysis of claims fi led by eSolutions customers. HMENEWS.COM 6/17 7/17 9/17 12/17 3/17 3/18 2/18 10/17 8/17 11/17 1/18 4/17 5/17 Most viewed stories in March 1. Stakeholders pitch bid reform 2. Industry wants answers 3. Amazon wants to disrupt health care, including DME 4. Mail-order changes a 'good fi rst step' 5. VGM zeroes in on respiratory 6. Noridian named new SMRC contractor 7. Inogen ramps up support for DTC biz 8. Medical supplies business 'explodes' *The Medicare Market Marker provides a monthly look at the number of Medicare benefi ciaries for whom the four MACs have allowed a claims payment. SOURCE: PDAC (number of allowed benefi ciaries) E 1 3 9 0 : O X Y G E N C O N C E N T R A T O R E 0 2 6 0 : S E M I - E L E C T R I C H O S P I T A L B E D (number of allowed benefi ciaries) E 0 6 0 1 : C P A P (number of allowed benefi ciaries) K 0 0 0 1 : S T A N D A R D W H E E L C H A I R (number of allowed benefi ciaries) (number of allowed benefi ciaries) K 0 8 2 3 : P O W E R W H E E L C H A I R * * HME NEWS POLL HMEDATABANK.COM The HME DataBank has the latest Medicare reimbursement data for the top 1,000 HME providers nationally in 103 key product cat- egories, as well as for all of the products in the NCB program. You can determine your market share, look for new product opportu- nities and check out your competition using the latest available Medicare data. Go to hmedatabank.com to learn more. data! data! **We are now tracking K0823 claims with certain modifi ers (NU, UE or RR/KH) to better refl ect the actual number of new allowed benefi ciaries under the 13-month capped rental. 1/17 10/17 9/17 11/17 12/16 2/17 3/17 7/17 8/17 4/17 5/17 6/17 "Referral sources have different sys- tems which are not a l l c o m p a t i b l e . " —Alan Heck, Walker H o m e M e d i c a l , Statesboro, Ga. "We accept e-referrals on multiple platforms. Some of them result in efficiency gains through streamlining processes. But others are niche platforms that specifi c docs want us to use." —Josh Marx, Medical Service Company 106,996 Region D 95,414 Region B 68,195 Region A 26,031 Region C 15,178 Region A 6,156 Region D Region B 12,934 Region B 50,747 Region D 66,214 Region C 103,230 Region A 43,964 260 Region B Region D 234 854 Region C Region A 148 43,120 Region C 16,816 Region B 14,194 Region D 17,994 Region A Month Percent denied Source: The Braff Group, 412-833-5733. The Braff Group M&A Insider Rehab 17, 19.6) DME (14.4, 16) Respiratory (10.8, 11.4) 1/17 10/17 9/17 11/17 12/16 2/17 3/17 7/17 8/17 4/17 5/17 6/17 1/17 10/17 9/17 11/17 12/16 2/17 3/17 7/17 8/17 4/17 5/17 6/17 1/17 10/17 9/17 11/17 12/16 2/17 3/17 7/17 8/17 4/17 5/17 6/17 NewsPoll based on 38 respondents. 191,618 Region C HME NEWS / MAY 2018 / WWW.HMENEWS.COM Databank Do you process orders and documen- tation electronically? This month we examine indemnifi cation caps for transactions in the lower middle market, defi ned here as those with a total economic value of $10 million to $25 million. Buyers typically require "indemnifi cation" from any problems or issues that occurred prior to the close of a deal. After rigorous due diligence—and to mitigate seller fears of having unlimited exposure "hanging over their heads"—buyers will often cap indemnifi cation at a percent of the total purchase price. So, what would explain why health care, with its vast exposure to compliance failures in billing and collection, licensure, clinical effi cacy, privacy and more, had the lowest caps? First, you've got to read the small print. In this case, the data covers general reps and warranties, and excludes "carve-outs"—often reserved for these very issues. Second, we speculate that with so much exposure outside of the caps, buyers are a tad more lenient on the general R&Ws, if for no other reason than to get the deal across the fi nish line. 23 1/17 10/17 9/17 11/17 12/16 2/17 3/17 7/17 8/17 4/17 5/17 6/17 What has been the biggest benefi t to your business? No

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