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  1. 08/16/2017
    HME News Staff

    WASHINGTON – Claims submitted by providers that have the highest claim error rates or billing practices that vary significantly from their peers will soon face increased scrutiny, CMS has announced.

    As part of an expanding “Targeted Probe and Educate” program, the Medicare Administrative Contractors will identify these providers through data analysis.

    “TPE claim selection is different from that of previous probe and educate programs,” the agency stated in an Aug. 14 announcement on its website. “Whereas previously the first round of reviews were of all providers for a specific service, the TPE claim selection is provider/supplier specific from the onset. This eliminates burden to providers who, based on data analysis, are already submitting claims that are compliant with Medicare policy.”

    Per the program, the MACs will review 20 to 40 claims per provider, per item or service, per round, for a total of up to three rounds of review. After each round, providers will be offered individualized education based on the results of their reviews.

    Providers with moderate and high error rates in the first round of reviews, will continue on to a second round of 20-40 reviews, followed by additional education. Providers with high error rates after the second round will continue to a third and final round of reviews and education.

    Providers with continued high error rates after three rounds of review may be referred to CMS for additional action, which may include 100% pre-pay review, extrapolation, referral to a Recovery Auditor Contractor, or other action.

    Providers may be removed from the review process after any of the three rounds of review, if they demonstrate low error rates or sufficient improvement in error rates, as determined by CMS.

    The program began as a pilot project in one MAC jurisdiction in June 2016 and was expanded to three additional jurisdictions in July 2017. CMS will expand the program to all jurisdictions later this year.

  2. 08/15/2017
    HME News Staff

    AUSTIN, Texas – Superior HealthPlan, a managed care company that’s administering part of the state’s Medicaid program, has decided to delay a contract with Medline until Oct. 1, according to the San Antonio Express-News.

    The contract, which includes 244 codes for DME and supplies, was set to start Sept. 1.

    Superior Health Plan, part of Centene Corp., also plans to recast the contract as “preferred provider” vs. “single source,” making it clearer that Medicaid recipients will still have their choice of provider, the newspaper reported.

    The changes to the contract come on the heels of a hearing before the state’s Committee on Human Services in the House of Representatives on Aug. 9. During the hearing, lawmakers suggested that Superior HealthPlan amend its notice to patients to say they can “opt out for any reason or no reason at all,” the newspaper reported.

    Prior to the hearing, a number of providers, including Respiratory & Medical Homecare and Alliance Medical Supply, had sent letters of protest to different offices of the Texas Health and Human Services Commission, as well as Superior HealthPlan.

    Superior HealthPlan’s contract in Texas is only one of many such contracts between managed care companies and distributors spreading nationwide.

  3. ‘We want to end the year sequentially flat’
    08/11/2017
    Liz Beaulieu

    ELYRIA, Ohio – Despite the excitement surrounding its recent clearance by the U.S. Food and Drug Administration to resume full operations at its Taylor Street manufacturing facility, Invacare CEO Matt Monaghan told investors Aug. 8 that the company is still trying to “report some conservatism.”

    Monaghan expects Invacare’s financial results to stabilize in the second half of 2017, but there are a number of factors that are tempering a rebound right out of the gate.

    “I want to end the year sequentially flat, quarter-over-quarter, so Q4 over Q3,” said Monaghan, also chairman and president, during a conference call to discuss financial results for the second quarter. “So we’ll see how close we can get on Q3 over Q2.”

    For the six months ended June 30, Invacare reported net sales of $465.2 million this year vs. $532.6 million last year. It reported a net loss of $40.3 million vs. $20.2 million.

    Monaghan acknowledged that it’s “hard to predict” how quickly providers will “come back” to its line of complex rehab products, which were most affected by the consent decree that limited manufacturing from its Taylor Street facility for almost five years.

    “It’s a little hard for us, just 10 days into that ability to sell freely,” he said.

    Additionally, Monaghan called the performance of Invacare’s respiratory product category in the second quarter “a little disappointing.” While there are signs that providers are buying more portable oxygen concentrators as they transition to non-delivery business models, POCs have been, traditionally, a small part of its product mix in the category.

    “There’s really incredible growth, and I’m excited to be participating in that (with our Platinum Mobile Oxygen Concentrator),” he said. “But the challenge is, the marketplace, I think, is putting their new asset purchase dollars into that category. So for us, the decline in respiratory really reflects a mix shift to a segment of that pie that's relatively small for us. So we see the exciting startup growth, but we've got to manage that mix shift.”

    “Conservatism” aside, Monaghan remains “bullish on the long term,” especially for Invacare’s lineup of complex rehab products, which includes the new TDX SP2 power wheelchair with LiNX Technology.

    “I have a lot of confidence in complex rehab because of the training and talent we have in the commercial organization, and the products we’ve given them,” he said. “What we see in the book of quotes and the commercial interests for appointments to get closed going forward—I’m relatively sanguine about mobility and seating and the complex rehab part of the business.”

    Invacare reported $233.5 million in net sales for the second quarter of this year compared to $275 million for the same period last year, a 15.1% decrease. For North America/HME, it reported $77.7 million in net sales compared to $110.7 million, an 86.4% decrease.

    Invacare reported a net loss of $23.5 million for the second quarter this year compared to a net loss of $11.58 million for the same period last year.

  4. 08/11/2017
    HME News Staff

    LAKE FOREST, Calif. – Apria Healthcare has launched a new program for patients on non-invasive ventilation that it says significantly reduces hospital admissions.

    As part of the Apria Clinical Evidence (ACE) program, respiratory therapists perform regularly scheduled home visits to help patients maintain compliance with therapy and intervene as needed to get patients back on track. During the visits, RTs monitor each patient’s progress and record their responses to a number of quality of life indicators, as well as document emergency department visits and unplanned hospital admissions.

    “Apria is uniquely positioned to help these patients reduce hospital admissions by providing them with the tools and support they need for success,” said Dan Starck, CEO of Apria Healthcare. “Through the ACE program, we have seen tremendous success in reducing hospital admissions when comparing the six months prior to initiating therapy with the six months post therapy, particularly for patients diagnosed with COPD.”

    Initial results from the ACE program are comparable to a recent study published in the Journal of Clinical Sleep Medicine, which demonstrated that multifaceted COPD intervention—including non-invasive ventilation, RT-led respiratory care and patient education—resulted in an 88% reduction in hospital admissions, according to Apria.

    Apria is offering the ACE program nationwide through its locations in Springfield and Wilmington, Mass.

  5. 08/11/2017
    HME News Staff

    LAKE FOREST, Calif. – Apria Healthcare has agreed to pay more than $750,000 to settle allegations that it billed Massachusetts residents for services already covered by MassHealth, the state’s Medicaid program.

    Under the settlement announced Aug. 9, Apria has agreed to pay $99,008 in restitution and $665,934 in penalties to settle allegations that the company improperly billed consumers between December 2011 and April 2017, according to Massachusetts Attorney General Maura Healey.

    Despite the settlement, Apria denies it violated any state laws.

    “We are pleased to have resolved this matter with the Massachusetts Attorney General,” said Raoul Smyth, Apria’s executive vice president and general counsel, in a statement. “Although Apria denies that it has violated any Massachusetts laws, this resolution reflects Apria’s desire to put this matter behind it so that it can continue to focus on the needs of patients.”

    Apria says it addressed the processes that were the focus of the Attorney General’s investigation long before this settlement was reached.

    Study: Bid program puts Medicare more in line with commercial insurers

    BETHESDA, Md. – A comparison of the prices Medicare paid for certain DME under its competitive bidding program in 2010 and the average prices that commercial insurers paid that same year supports the conclusion that CMS overpaid for DME, according to a new study conducted by the Health Care Cost Institute and published this month in Health Affairs. On average, the Round 1 Rebid prices for the seven items included in the study were 34.7% lower than the prices in the Medicare fee schedule for 2010. On average, commercial payers paid 28.7% less than Medicare for the same items in 2010. “This suggests that in the nine program MSAs, the program resulted in prices that were generally comparable to but lower than the prices obtained by large commercial insurers,” the study’s authors say. Because the bid program has better lined up prices from Medicare with those of commercial insurers, the study’s authors argue it is an “effective mechanism for achieving savings,” with one caveat. “If the concerns about the program’s long-term sustainability can be resolved, competitive bidding for DME and similar items may be an effective mechanism for achieving savings in Medicare, relative to historic fee schedule prices,” they say. The Health Care Cost Institute is a non-partisan, non-profit organization that aims to provide complete, accurate, unbiased information about healthcare utilization and costs to better understand the U.S. healthcare system, according to its website.

    Trump stalls sleep reg for drivers, rail workers

    WASHINGTON – President Donald Trump, who has pledged to drastically slash federal regulations, has sounded the death knell for a regulation to require sleep apnea screening for commercial drivers and rail workers, according to news reports. The Federal Railroad Administration and the Federal Motor Carrier Safety Administration said late last week that they are scraping the regulation, arguing that it should be up to trucking and railroad companies to decide whether or not to screen their employees. Last year, however, the agencies announced a proposalto require screening for commercial drivers and railroad workers, and sought public input. Deadly rail crashes in New York City and New Jersey, as well as several highway crashes, have brought the issue to the forefront. In the Metro-North train crash in 2013, the engineer fell asleep at the controls because he had a severe, undiagnosed case of sleep apnea. In the New Jersey Transit train crash in September, the engineer also suffered from undiagnosed sleep apnea.

    New Apria program helps reduce readmissions

    LAKE FOREST, Calif. – Apria Healthcare has launched a new program for patients on non-invasive ventilation that it says significantly reduces hospital admissions.

    As part of the Apria Clinical Evidence (ACE) program, respiratory therapists perform regularly scheduled home visits to help patients maintain compliance with therapy and intervene as needed to get patients back on track. During the visits, RTs monitor each patient’s progress and record their responses to a number of quality of life indicators, as well as document emergency department visits and unplanned hospital admissions.

    “Apria is uniquely positioned to help these patients reduce hospital admissions by providing them with the tools and support they need for success,” said Dan Starck, CEO of Apria Healthcare. “Through the ACE program, we have seen tremendous success in reducing hospital admissions when comparing the six months prior to initiating therapy with the six months post therapy, particularly for patients diagnosed with COPD.”

    Initial results from the ACE program are comparable to a recent study published in the Journal of Clinical Sleep Medicine, which demonstrated that multifaceted COPD intervention—including non-invasive ventilation, RT-led respiratory care and patient education—resulted in an 88% reduction in hospital admissions, according to Apria.

    Apria is offering the ACE program nationwide through its locations in Springfield and Wilmington, Mass.

    Inspired by Drive launches online community

    SANTA FE SPRINGS, Calif. – Inspired by Drive has launched “Live Inspired,” an online community for special needs families. It features a weekly guest blog and other resources, and offers families a place to connect. “Our commitment to special needs families goes beyond our products,” said Matt Lawrence, vice president and general manager. “The Live Inspired community is an extension of our mission to enhance the quality of life of the people we touch and our commitment to families.”

    AccessNSM taps new vice president

    NASHVILLE, Tenn. – AccessNSM, the accessibility division of National Seating & Mobility, has named Kalen McKenzie vice president. McKenzie previously served as regional account manager at Dornier MedTech and vice president of national accounts at Invacare. “Kalen’s experience and expertise will be extremely valuable to AccessNSM,” said Bill Mixon, NSM CEO, in a press release. “His leadership will play an integral role in the continued strategic growth of the company.” As vice president, McKenzie will focus on integrations and organic growth for AccessNSM.

    Pedors launches footwear program

    ROSWELL, Ga. – Pedors Shoes has introduced a Geriatric Footwear Program that provides PTs and OTs with a discount code they can share with their patients to help offset the cost of therapeutic footwear. Pedors believes the program can help to address Medicare’s broken audit system and the emergence of e-commerce, which it says have driven orthotics fitters and pedorthists out of the market and made it harder for patients to find footwear. “The objective of the program is to keep the cost of orthopedic footwear on par with what a patient might expect to pay for a pair of sneakers,” said Stephen O’Hare, president.

    AAH seeks nominations for homecare champion

    WASHINGTON – AAHomecare is accepting nominations for the 2017 Van Miller Homecare Champion Award. The award, which was established in 2016when the association renamed the AAHomecare Champion Award, recognizes a member who has made exceptional contributions to home care. Nominations can be submitted to Sue Mairena at suem@aahomecare.org until Sept. 8. The award will be presented during the Stand Up for Homecare reception at Medtrade on Tuesday, Oct. 24. Missy Cross, vice president of the homecare division of O.E. Meyer Co., received the inaugural award last year.

    Aeroflow donates breast pump kits

    ASHEVILLE, N.C. – Aeroflow and Ameda, a breast pump manufacturer, are partnering with Grady Memorial Hospital in Atlanta to provide breast pump kits for new mothers to use at Dekalb Detention Center. The program gives the mothers, most of whom will be in Dekalb for short periods of time, the opportunity to initiate and maintain lactation so they can continue to feed their baby breast milk once they’re reunited at home. "Many women at Dekalb believe they are not allowed to breastfeed, even in the hospital, but I encourage them to consider doing so, even if it's only for a short period of time," said Kelly Webb, the Lactation Program Coordinator at Grady Memorial Hospital. "Access to a breast pump allows a new mother to maintain supply and remain emotionally connected to her infant." Aeroflow Breastpumps, a subsidiary of Aeroflow Healthcare, is a DME provider specializing in helping pregnant and nursing women qualify for their breast pumps through their insurance and the Affordable Care Act.

    Last call for HME Woman of the Year nominations

    WATERLOO, Iowa – The nomination period for the HME Woman of the Year award closes Monday, Aug. 14. To nominate a woman for the award, all you have to do is complete four questions stating how the woman has made an impact on the industry. Women are also encouraged to nominate themselves. Last year’s recipient, Dr. Kirsten Davis, has used the award as a platform for networking with other women in the industry, and sharing successes and obstacles that impact their businesses. “I would encourage everyone to take a minute to really think about what they do, what they've done, and who they've touched,” said Davin. “By really sitting down and reviewing your career, we often find out that we have a greater impact than we think we do.”  The winner of the award will be announced at Medtrade in October.

    QS/1 boasts QIR-certified installers

    SPARTANBURG, S.C. – QS/1 has met the stringent guidelines of the Qualified Integrators and Resellers (QIR) Program, giving its pharmacy and provider customers assurance that they meet regulatory requirements to protect consumer credit card data. This Payment Card Industry Data Security Standard (PCI DSS) qualification details the procedures for a secure installation and continued maintenance of payment application systems. QS/1 integrators are PCI-certified under the QIR program to install, configure and maintain payments systems, like the company’s Point-of-Sale. “QS/1 has a history of leading the way in point-of-sale technology,” said Saul Factor, QS/1 president. “With network breaches at an all-time high last year, we want to ensure we stay ahead by taking every step possible to protect our customers and those they serve by reducing the risk of a security breach.”

    EZ-Access makes improvements

    ALGONA, Wash. – EZ-Access has updated its website, www.ezaccess.com, and strengthened its sales team. The company, which makes accessibility solutions, worked with VGM Forbin to update its website to improve the experience for current and prospective customers who are searching for products. The website, which was built to perform well on all devices, features products segmented by categories, a dealer contact form, a live chat and stronger security. EZ-Access has also added Scott Haisch as West Region Business Manager, reporting directly to David Heinz, director of sales for the company’s Residential Access division. Previously, Haisch was managing director of an international sales and marketing consulting company.