WASHINGTON – O&P stakeholders yesterday called on lawmakers to ensure that any healthcare reform plan does not return America to a pre-ACA world where amputees can’t afford a leg.
“Before ACA, amputation was considered a pre-existing condition and there were unreasonable limits in insurance coverage,” said Dr. Jeff Cain, a Denver-based physician and head of the advocacy program for the Amputee Coalition. “Without insurance, an amputee wouldn’t be able to afford a leg to stand on.”
Cain spoke during a phone-based news conference co-hosted by the American Orthotic & Prosthetic Association and the Amputee Coalition June 27. The call was held after a Congressional Briefing on “The Value of Rehabilitation and Habilitation Services and Devices,” held by Sen. Tammy Duckworth, D-Ill., who sharply criticized the Senate healthcare reform bill, which was unveiled June 22.
“All of the problems with this bill are especially true for Americans with a disability,” said Duckworth on the call. “Overall this bill would force working families to pay more money to receive significantly worse care.”
The three priority issues for amputees mirror those of other populations: no cuts to Medicaid that would curb access to treatment and devices; no waivers to services that are covered as an essential health benefit; and no changes to authorize higher premiums for pre-existing conditions, in this case, amputation.
“We want to be ensure that amputees will not be excluded from any insurance plans,” said Michael Oros, president of AOPA, on the call. “It has been demonstrated that access to prompt and proper care can save lives and money.”
There are more than 2 million amputees in the United States, with 500 people joining those ranks each day due to vascular disease, cancer and trauma.
Providing limbs ensures amputees will lead more productive lives, said Adrianne Haslet, a Boston marathon bombing survivor and world class ballroom dancer, who has become an amputee rights advocate.
“In the past four and a half years, I have run a marathon on a blade, dove with sharks and danced again,” she said during the call.
WASHINGTON – A new bill in the House of Representatives would pave the way for wigs to be covered as durable medical equipment.
The bill, H.R. 2925, recently introduced by Rep. Jim McGovern, D-Mass., would provide access for Medicare beneficiaries that a dermatologist, oncologist or attending physician could certify as a medical necessity as part of rehabilitative treatment, according to a press release from The VGM Group.
“This is the beginning of a very long road to getting this bill passed,” said Nikki Jensen, vice president of Essentially Women, a division of VGM. “No matter how small you think your voice is today, it will take providers and beneficiaries speaking out together to get us to the finish line.”
Essentially Women will be engaging a grassroots coalition of providers across the country to raise awareness and gain support to get H.R. 2925 passed. Providers are encouraged to message their members of Congress and use the phone script to call their representative through the VGM Action Center.
YARMOUTH, Maine – HME stakeholders are cheering a hard-fought win for a remark code that will allow providers to identify when claims have been adjusted due to a retroactive delay to reimbursement cuts in non-competitive bidding areas.
The DME MACs agreed with the need for the code, found one that was appropriate and forwarded the request to CMS. But initially, they were told no, stakeholders say.
“There was push back, because of the additional programming time it might require,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “CMS said, ‘We don’t want to hold up the adjustments,’ and we don’t want to, either, but we need a code. The industry shared its concerns and, lo and behold, they were able to program the code.”
The adjustments are mandated by the 20th Century Cures Act. A provisionin the act delays a second round of reimbursement cuts in non-bid areas from July 1, 2016, to Jan. 1, 2017, allowing providers to recoup a portion of six months worth of payments.
The remark code—N689—will not only give providers a way to parse out Cures adjustments from other reprocessed claims, but also, theoretically, give software vendors a data point for creating customized reports, stakeholders say.
“That way providers know how many claims have been adjusted, how much money they’ve collected, and, just in general, how things are moving through,” said Andrea Stark, a reimbursement consultant for MiraVista, who hosted a webcast recently on how providers should be preparing for the adjustments.
Stakeholders breathed a sigh of relief when providers started receiving adjustments in May, but it turns out the MACs were just running two test batches. The MACs, which are still processing their normal load of claims, wanted to see how much additional work processing the adjustments will be, they say.
“They watched to see how many of them suspended for manual customer service intervention and will require people power,” Stark said. “They did notice some issues, including recoupments that were requested after an overpayment had already been paid, and recoupments that were initiated for skilled nursing facility visits where the data may have changed after the fact.”
While stakeholders have argued the adjustments are taking too long, they acknowledge it’s a huge undertaking, with the MACs expected to process 140,000 claims per day across the four jurisdictions once they’re running full bore in July.
“I think it’s been a big issue for suppliers and the MACs, because of the volume and how it needs to be handled,” said Ronda Buhrmester, a reimbursement specialist for the VGM Group. “We’re hoping once they work out some of the kinks it will go quicker.”
WASHINGTON – With only days to spare, stakeholders have succeeded in getting CMS to refrain from cutting reimbursement for accessories for complex rehab power wheelchairs.
The agency announced late on Friday that it would not apply competitive bidding pricing to accessories on July 1, 2017.
“This speaks well of the CRT community, including the consumers,” said Don Clayback, executive director of NCART, who was on the Hill the week of June 19. “It has been a year and a half of very hard work.”
CMS said in the announcement that it has “reconsidered” and decided to preserve reimbursement for accessories for Group 3 or higher complex rehab power wheelchairs. It said providers should continue to use the KU modifier when billing for accessories with dates of service beginning July 1. It said no additional action would be required.
CMS did not, however, extend the policy change to accessories for complex rehab manual wheelchairs.
“We will pursue relief from last year’s cuts to these accessories as we continue to work with Congress and CMS to protect access,” Clayback said in a bulletin to members.
Upon hearing from champions in Congress this week that a fix was in the works, Seth Johnson, vice president of government affairs for Pride Mobility Products, said, “It sounds like a positive development. We have a little extra bounce in our step. Things are moving.”
CMS originally planned to apply bid pricing to accessories on Jan. 1, 2016, but Congress intervened in December of 2015, passing legislation with a one-year delay, and again in December of 2016, passing legislation with a six-month delay.
Pressure has been high to stop the cuts. NCART and NRRTS, as well as the United Spinal Association, hosted congressional fly-ins in April and June, and one of their “asks” was getting legislators to, once again, intervene.
Then in June, a “Dear Colleague” letter signed by 154 members of the House of Representatives was sent to HHS Secretary Tom Price and CMS Administrator Seema Verma, asking them to use their authority to stop the cuts.
Additionally, in March, bills were introduced in the House and Senate to stop the cuts. Sens. Bob Casey, D-Pa., and Rob Portman, D-Ohio, introduced S. 486; and Reps. Lee Zeldin, R-N.Y., and John Larson, D-Conn., introduced H.R. 1361. The bills have 21 and 101 co-sponsors, respectively.
Stakeholders have argued that accessories for complex rehab wheelchairs, like the wheelchairs themselves, are exempt from competitive bidding per the Medicare Improvements for Patients and Providers Act of 2008, or MIPPA.
Yet CMS issued a “Frequently Asked Questions” document in December 2014 that outlined their plans to use pricing obtained from its bids for accessories for standard wheelchairs to reduce reimbursement for accessories for complex rehab wheelchairs. Accessories for complex rehab wheelchairs include seat/back cushions, tilt/recline systems and specialty controls.
As part of the policy change, CMS has now revised that FAQ.
NEW YORK – Sleep patient volume grew 4.4% in the last 12 months and is expected to grow 5.1% in the next 12 months, according to respondents to the second quarter 2017 HME Sleep and Oxygen Survey conducted by Needham and HME News.
That’s up significantly from 0.8% and 2.5%, respectively, in a prior survey.
Flow generator prices declined 1.8% in the last 12 months (vs. a decline of 3.8% in a prior survey), and mask prices declined 3.1% (vs. 4.4%), according to respondents.
“This represents a reversal of the worsening price declines seen in our prior two surveys that followed the 2016 Medicare reimbursement cuts and seems to indicate that pricing declines are returning to the historical range,” Mike Matson of Needham wrote in his report highlights.
Respondents indicated that interest in travel CPAPs is on the rise: They reported 5.5% of their sleep patients purchased travel CPAPs in the last 12 months and 10.6% are expected to purchase the devices in the next 12 months.
ResMed’s and Philips Respironics’ flow generators were rated equal by respondents, while ResMed’s masks were rated highest, with Respironics’ very close behind, according to the survey.
Respondents expect ResMed’s share of flow generator purchases to decrease 2.3% and its share of mask purchases to decrease 3.6% in the next 12 months. They expect Respironics’ share of flow generator purchases to decrease 1.1% and its share of mask purchases to increase 2%.
On the oxygen side of the market, respondents expect portable oxygen concentrators to increase from 16.6% of the ambulatory oxygen market to 21.4% over the next 12 months, which implies 29% growth, down from 45% in a prior survey. They rated a private label POC from Inogen highest.
New company Essity lists on Nasdaq
PHILADELPHIA – Essity, a global hygiene and health company, listed on the Nasdaq Stockholm on June 15. The listing follows SCA Group’s decision to split into two independently listed companies: forest products company SCA, and Essity. Essity says it plans to continue to expand on the market growth of the Tork, TENA and JOBST brands. “With the launch of Essity we have a new name and an even stronger sense of purpose—improving well-being by providing leading hygiene and health solutions,” said Don Lewis, president, Professional Hygiene, said. “Our hygiene and health focus will allow us to bring new innovations to market while offering our customers and consumers the insights, knowledge and best practices that can only come from one of the world's leading hygiene companies.” Essity says it will begin phasing out the Tork and TENA brands over the next two years, replacing them with new Essity branding.
Upstep launches orthotics service
NEW YORK – Upstep is launching an online custom orthotics service in the U.S., the company announced in a press release. Customers simply place an order online and receive a footprint kit at home. The customer then follows instructions to make a foot imprint and send it back to the company. Upstep uses 3D technology to scan the footprint and create a customized orthotic based on that customer’s particular needs.
USS streamlines A/R
DAVISON, Mich. – Universal Software Solutions has added a Collections & Denials Module to its Healthcare Data Management Software, the company announced in a press release. The automated software will streamline accounts receivables by generating prioritized work lists sorted by criteria into an electronic grid. “This module enables HME billers to be far more efficient and focused on their high value billing claims and denials,” says Christopher Dobiesz, president. “It also allows for a shared cooperative work space between billing staff and managers.”
Court sides with Fairview HME
ST. LOUIS – The U.S. Court of Appeals for the Eighth Circuit has upheld the dismissal of a class action lawsuit filed against Fairview Health Services alleging its HME division made unauthorized telemarketing calls in violation of the Telephone Consumer Protection Act. The court ruled that Samuel Zean, who filed the complaint in Minnesota, had given prior express written consent to receive calls. The TCPA prohibits any person from making “any call using an automatic telephone dialing system or an artificial or prerecorded voice to any telephone number assigned to a cellular telephone service.” Fairview provided documents with Zean’s signature, giving the company permission to contact him by phone, including by cell phone. Fairview Health Services is a nonprofit corporation that operates hospitals and clinics in Minnesota and sells HME under the name Fairview Home Medical Equipment.
Celebrations: Orchid Medical, Peritech Home Health, RRI
Orchid Medicalin Orlando, Fla., is celebrating its 15-year anniversary. The company was established in 2002 as a regional DME provider to the workers’ compensation market. Among the company’s achievements in the past 15 years are a new DME retrospective repricing program, and an expansion beyond DME into ancillary services, including home and vehicle modifications…Peritech Home Health in Wyomissing and DuBois, Pa., is celebrating its 25-year anniversary. The company started as a DME provider that serviced pregnant women with high-risk diagnosis of pre-term labor. From there it has evolved into a full-service maternal child home health agency that services pregnant women, women after delivery and children…Responsive Respiratory, Inc. celebrates 15 years in business as a manufacturer and distributor of high-pressure home oxygen equipment and supplies this year. Over the last decade and a half, RRI has grown from a regional startup to a national manufacturer and distributor.
Convaid names new ambassadors
TORRANCE, Calif. – Convaid | R82 has added two new ambassadors to represent its growing population of product enthusiasts. Joining ambassadors Cesar, Emerson and Andrew are Jax and Z’Mya. The ambassadors are community volunteers who serve one-year terms representing Convaid at community events, engaging online and participating in other activities. "The Ambassador Program is an important part of our community outreach. Not only are our ambassadors faithful brand fans, they are the Convaid | R82 eyes and ears on the ground,” said Nanneke Dinklo, director of marketing. “They contribute valuable product and community insights, which we use for research and development to deliver improvements and new products.” Jax and Z’Mya will make special appearances at Abilities Expos in their respective regions, write blog posts, share videos, contribute to product case studies and engage on an ongoing basis with the Convaid | R82 online community. Convaid established the ambassador program in 2015.
Convaid | R82 align discounts
TORRANCE, Calif. – Convaid | R82 now have the same primary discount, 30%, according to a press release. Secondary discounts will change accordingly, to reflect the same or slightly different total discount customers used to receive on R82 products. For more information, customers should contact their sales rep or call 844-876-6245. Convaid and R82 have slowly been combining functions since Convaid was sold to Etac in 2015.
Short takes: Golden Technologies, Mediware, Home Care Medical
Rich Golden, CEO of Golden Technologies, was recently honored by Junior Achievement of Northeastern Pennsylvania with the Entrepreneur of the Year Award at the annual Business Hall of Fame Dinner & Awards Ceremony. Golden launched the company in 1985 in a one-care garage. Today, it encompasses a large facility dedicated to manufacturing lift chairs. “I attribute the tremendous growth and success of Golden Technologies to the continued hard work and determination of our employees, many of whom have been with us for a very long time,” Golden said. “We’re just in a bigger garage.” Junior Achievement provides programs to students teaching work readiness, entrepreneurship and financial literacy…Mediware has announced that Biologic Infusion Pharmacy has chosen Mediware Reimbursement Services for fullly outsourced billing and collections services. Biologic Infusion Pharmacy was founded in 2013 and specializes in infusion therapy for patients throughout southern California. After recent staffing changes in its reimbursement department, the company’s president began evaluating billing and collections options, looking for ways to get the job done without the hassle of hiring and training new staff…Home Care Medical has reaccredited by the Joint Commission. The New Berlin, Wis.-based provider became the state’s first accredited HME provider in 1990. Serving southeastern Wisconsin since 1974, Home Care Medicare provides enteral nutrition, rehab technology, respiratory services, HME and bracing.