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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News 4 www.hme N ews.com / ju N e 2018 / hme N ews VGM's latest business playbook - Provides the resources to take on any new challenges. INDUSTRY INSIGHTS: HOW TO CAPITALIZE ON OPPORTUNITIES IN POST-ACUTE HEALTH CARE Download today at playbook.vgm.com! FREE to VGM members & vendor partners Abbreviated version available to non-members Liz Beau L ieu, e ditor y ARMOUTH, Maine – Stakeholders are not happy that C2C Innovative Solutions appears to be losing its gig as the Qualified Independent Contractor for HM e . Jacksonville, Fla.-based C2C has popu- larized a demonstration project that allows HM e providers to speak with reconsidera- tion professionals by phone to try and resolve their cases. In 2017, 64% of claims that were involved in the demo were found fully favor- able and 3% were found partially favorable, AAHomecare recently reported. "C2C has been great to work with," said Ronda Buhrmester, a reimbursement special- ist with the VGM Group. "They're following CMS's directives, but they see the issues, and they want to help." AAH also reported that, in 2017, the demo had reopened 54,128 claims and withdrew 27,132 claims from the backlog at the admin- istrative law judge level. The word on the street is that CMS is switching the QIC contract from C2C to Reston, Va.-based Maximus to save money. Stakeholders fear switch "When you provide excellent customer service and tools like C2C does, it costs money," said Mary Stoner, president of e lec- tronic Billing Services Inc. Stakeholders say C2C is protesting the decision, and they're crossing their fingers. "They're trying to get their expenses down to come up with a better price," Buhrmester said. "We're waiting to see what the outcome of that is." If the contract stays with Maximus, stake- holders fear they'll have a lot of work to do, as they say the company has little, if any, expe- rience with DM e . Maximus currently holds one QIC contract for the West Jurisdiction for Part A, while C2C currently holds five QIC contracts, including for HM e and the DM e Phone Demonstration. "We're going to have to provide education (to Maximus) on how to process claims," Stoner said. "We've notified CMS and we've been assured that they're watching this." Switching the contract to Maximus may also create instability in an already unstable audit environment, stakeholders fear. "It could exacerbate the situation at the A l J, which is already untenable," said Andrea Stark, a reimbursement consultant with MiraVista. hme not so Q i C 'It could exacerbate the already untenable situation at the ALJ' streamlining processes, but others are niche platforms that specific doctors want us to use due to their own preferences. That makes it hard for our teams to manage, when there are multiple ordering platforms with varying degrees of integration into our e RP." Another stumbling block: e lectronic ordering requires buy-in from both pro- viders and referral sources, and some referral sources are holding back, respon- dents say. "As a pharmacy/DM e , we are at the mercy of the processes the pharmacy side of the business chooses to use," wrote one respondent. "That means we still use a paper fax machine and have zero com- munication between pharmacy and DM e computer systems." hme patient and ourselves." Parachute Health and Apria Healthcare also announced recently that they are now more widely offering their e-prescribing platforms to providers. While a majority of respondents to the poll say they are already using electronic technology in their businesses (67%), there are still significant stumbling blocks to it being ubiquitous. Chief among them: the number of platforms being offered and used. "We accept e-referrals on multiple plat- forms," wrote Josh Marx of Medical Ser- vice Company based in Cleveland. "Some of them result in efficiency gains through E - TE c HNOLOG y C o N T i N u E D f R o M p A g E 3 "This is the first time, in my expe- rience, that CMS has acknowledged major problems," said Jay Witter, senior vice president of public policy for AAHomecare. "We're seeing through the disappointment." At press time in May, AAHomecare was still analyzing the impact before determin- ing next steps. "We need for all bid areas to get relief, but we need to get an accurate read of this to give lawmakers further recommenda- tions," Witter said. "We've been commu- nicating with folks on the Hill and will probably go back to them with a request for legislation to fulfill the rest of the relief that's needed." Gallagher already had a meeting planned with Sen. Chuck Grassley's office in the wake of the IFR being released. "We want to point out the stupidity of this," he said. "CMS said 'yes, there are problems,' but they didn't fix them. We have to go back to Congress and tell them, 'you have to fix it.'" hme IFR FALLS SHORT C o N T i N u E D f R o M p A g E 3

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