HME News

JUN 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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into effect, a lot of beneficiaries will con- tinue to be vulnerable to access issues, says John Gallagher, vice president of gov- ernment relations for VGM. "The majority of the population outside the CBAs are not going to be covered," he said. "If you've got a hospital in Butte, Mont., that wants to discharge a patient to a small town that's considered not rural, providers are going to say, 'I don't go there.' It's sheer incom- petence by CMS." CMS did acknowledge that there are many issues with the bid program—like the oxygen "double-dip"—that need to be fixed, say stakeholders. rates, but only from June 1, 2018, to Dec. 31, 2018, instead of retroactively to Jan. 1, 2017, as the industry had sought. F u rt h e r m o re , t h o s e s e v e n months of relief will only apply to rural and non-contiguous CBAs. That's in stark contrast to what lawmakers intended and to a pro- vision in the 21 st Century Cures Act that called for a roll back of reimbursement cuts in all non-bid areas. "The (IFR says it) is a contin- uation of the Cures Act payment relief, but then it's limited to Hawaii, Alaska and these super-rural areas," said Bachen- heimer. "It is really very limited." That means, even when the IFR goes ■ Switching QIC contractors could worsen situation at ALJ, says Andrea Stark. See story page 4. Round 2019: Questions, no answers . . . . . . . . . . . . . . . . . . 3 Noridian takes over SMRC contract . . . . . . . . . . . . . . . . . . 3 MAMES honors Heitkamp, Thune . . . . . . . . . . . . . . . . . . . . 3 Newspoll: Providers have high hopes for e-technology . . 3 News www.hme N ews.com / ju N e 2018 / hme N ews 3 Briefs VG m joins work group on electronic medical documentation WATERLOO, Iowa – The VGM Group and its membership has been invited to participate in a CMS work group on electronic medical documentation. VGM will represent DME- POS providers in the work group, which will have representation from several different provider groups. "While the concept of elec- tronic medical records is not new, this initia- tive of utilizing technology to allow provid- ers the opportunity to easily communicate and receive proper patient documentation is something that the DME industry strug- gles to gain from other provider communi- ties," VGM stated. The work group seeks to, among other things, establish pilot pro- grams with providers to demonstrate secure exchange of health information, and support adoption of real-world use cases to advance secure and standardized electronic data ex- change for medical documentation requests and responses. u pdate: c 2 c phone demo WASHINGTON – C2C Innovative Solutions, the QIC contractor, reopened 54,138 claims and withdrew 27,132 claims from the Adminis- trative Law Judge backlog in 2017, accord- ing to a bulletin from AAHomecare. Of those who participated in the telephone demon- stration, 64% of the claims were found fully favorable and 3% were found partially favor- able. AAHomecare also reports that C2C has also lost their QIC contract, a decision it expects the contractor to appeal. m edicare Advantage gets 3.4% increase WASHINGTON – CMS will increase average payments for health insurers that manage Medicare Advantage plans by 3.4% for 2019, the agency announced on April 1. CMS initially proposed a 1.84% increase, according to news reports. The agency will also make a number of policy changes to MA plans, including codifying key aspects of the Star Ratings system and revising the regulations controlling maximum out-of- pocket limits. AA h taps Bachenheimer for general counsel WASHINGTON – AAHomecare has retained Brown & Fortunato to provide a range of le- gal and advisory services. Long-time HME industry advocate Cara Bachenheimer, who is set to open a Washington, D.C., lobbying office for the Amarillo, Texas-based law firm in June, will take the lead role representing the association's regulatory and legislative priorities. "I have had a front-row view of Cara's work on HME public policy issues over the years, and I have always come away impressed by her depth of knowledge and strategic thinking," said Tom Ryan, pres- ident and CEO of AAHomecare. Bachen- heimer has served as senior vice president of government relations for Invacare for the past 14 years. IFR falls far short of bid relief 'disappointed' MAMES honors Heitkamp, Thune The North Dakota and South Dakota members of the Midwest Association of Medical Equipment Services & Supplies have presented Sen. Heidi Heitkamp, D-N.D., and Sen. John Thune, R, S.D., with MAMES Legislative Champion Awards for their work supporting the HME industry. Heitkamp and Thune have both been champions of the industry's efforts to provide relief from Medicare's competitive bidding program in rural areas. After being presented with the award, Heitkamp indicated that she would be willing to work with Thune to introduce a Senate companion bill to H.R. 4229, according to a MAMES bulletin. Poll respondents have high hopes for e-technology By Liz Beau L ieu, e ditor E le CTR on IC o RD e RI n G and docu- mentation have dominated the head- lines in recent weeks, and it's about time, say the respondents to a recent HM e n ewspoll. AAHomecare recently announced that it would be researching e-prescrib- ing platforms to recom- mend the best solution for its provider members, and the VGM Group recently announced that it would be joining a CMS work group to advance electronic SMRC: Familiar face takes on contract E - T E c H N O L O G y S E E p A g E 4 Jay Witter medical documentation. "We are an independent DM e company and not affiliated with a hospital, (so) we don't have access to e pic and other sys- tems—our notes and prescriptions come in via fax," wrote one respon- dent. "We have hopes that this will change with AAH and VGM working on an electronic solution for the industry. We very much see the need to handle this documentation electroni- cally. This would save so much time, which will, in turn, benefit the hme NEWS POLL By Theresa F L aher T y, Managing e ditor WASHINGTON – The long-anticipated interim final rule landed with a thud in May, when it became apparent that it offered little in the way of bid relief, say industry stake- holders. "It's not the IFR we were expecting," said Cara Bachenheimer, senior vice presi- dent of government relations for Invacare. "They didn't even do half of what we were anticipating and, more importantly, what folks on Capitol Hill were anticipating." The IFR, published in the May 11 Fed- eral Register, applies the 50/50 blended I F R f A L L S S H o R T S E E p A g E 4 'We have to go back to Congress and tell them, 'you have to fix it'' By Liz Beau L ieu, e ditor FARGO, N.D. – n oridian Healthcare Solutions has taken over yet another CMS contract. The company, which is already the Medi- care Administrative Contractor for jurisdic- tions A and D, and the Pricing Data Analysis and Coding contractor, among other things, has been awarded a $227 million contract to be the new Supplemental Medical Review Contractor. " n oridian has extensive DM e experience in the field, so this is definitely in their wheel- house," said Andrea Stark, a reimbursement consultant with MiraVista. "I think this is a good thing going forward." CMS previously contracted with o maha, n eb.-based StrategicHealthSolutions to con- duct post-pay review audits as the SMRC. Reimbursement consultant Mary Stoner also believes n oridian is a good pick. She has worked closely with the company in her work on the DM e RC Advisory Committee for Jurisdiction D. "They're a go-to for us on that committee," said Stoner, president of e lectric Billing Ser- vice Inc. "We've had questions for the SMRC that we've sent over and over, and never received a response. We already have a rela- tionship with n oridian, so we know they're going to be answering those questions." There are some, however, that take pause with giving n oridian the power to conduct not only pre-pay reviews as a MAC but also post-pay reviews as the SMRC. "People are a little uneasy with that," said Ronda Buhrmester, a reimbursement special- ist with The VGM Group. hme

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