Archive: February 2007

FARGO, N.D. - Unpaid claims continue to pile up at a disturbing rate, but Noridian, the Region D MAC, has begun making good faith efforts to solve the problem, providers say. As of Jan. 15, there were 947 claims older than 90 days and 22,939 claims older than 61 days. "The actual volume of claims suspending for manual review has been greater than our projections," Noridian stated in a release. "We realize our high volume of suspended claims is impacting cash flow for some suppliers." At one point,...

Providers who believe they must become accredited to submit bids in the first round of national competitive bidding left CMS's Jan. 30 Open Door Forum flabbergasted. CMS's goal is to have all of its Medicare Part B providers accredited--especially those in the top 20 MSAs--as soon as possible. At the forum, however, it became clear that there is no deadline on the books. Furthermore, "there is a provision in the statute that does say the quality standards should not delay the start of NCB," stated...

While CMS continues pushing providers to get their national provider identification numbers (NPI), some in the industry have expressed concern over the lack of a central directory listing physician NPIs. "That is one of the biggest stumbling blocks to prevent fully compliant implementation of NPI across the board without claims delay," said Andrea Stark, a Medicare consultant for MiraVista. "That information should be made public to facilitate the coordination of that." Beginning May 23, HMEs must...

James Taylor, owner of Vejay Oxygen, West Suburban Medical Rental and Westborough Home Health, was sentenced in January to two and a half years in prison for allegedly billing expensive DME to Medicare and Blue Cross Blue Shield but never delivering it...Dr. David Tamaren was ordered in January to spend three years on probation for allegedly prescribing diagnostic testing and DME that was not medical necessary. He also kept inaccurate records of treatment, and prepared and submitted improper medical...

WASHINGTON - Still raw from CMS's overhaul of the power mobility benefit, the rehab industry has begun to prepare for another potential blow, this time to manual wheelchairs. Discussions with CMS should "heat up" this spring, said Seth Johnson, chairman of AAHomecare's rehab council and vice president of government affairs for Pride Mobility. "CMS has indicated that they plan to go through manual wheelchair coding, coverage and pricing in detail and break it out in the same way they did power wheelchairs...

SPRINGFIELD, Mo. - An ice storm that blacked out large tracts of Missouri, Kansas and Oklahoma the first weekend in January forced even the most well-prepared HME providers to find creative ways to continue servicing oxygen patients. Employees at Bach Medical Supply in Springfield, Mo., for example, powered cell phones and shop lights with wheelchair batteries, so they could field calls and ready tanks for patients no longer able to use concentrators. When a major distributor of specialty gases was...

Q. I heard there is a new group of administrative law judges hearing Medicare appeals. Is it still worthwhile to appeal my denied claims to an ALJ? How likely am I to succeed? A. In 2005, the hearing process for Medicare Part B claims changed radically. Since 1989, all of these appeals had been heard by experienced judges with the Social Security Administration. However, the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) mandated that this caseload be transferred to...

Q. What is management through focused measurements, and how will it help me improve how I run my company? A. Focused measurements provide the information that managers need to ensure that the organization is on the right track. HME providers should develop focused reporting in two important areas. They are cash management and EBITDA. Cash measurements indicate the status of the company's balance sheet accounts. EBITDA reflects the revenue and expense accounts used to calculate profit and loss. Each...

WASHINGTON - Providers can now bill separately for several power wheelchair components, according to a DME PSC Bulletin published Jan. 26. Providers can bill separately for angle adjustable footplates for Group 3, 4 and 5 power wheelchairs for claims with dates of service on or after Jan. 1, 2007. They can also bill separately for sling/solid seat/back, non-standard seat widths and/or depths for Group 3 and 4 power wheelchairs. "This will really help to improve total reimbursement," said Seth Johnson,...

Ever since CMS announced that HME suppliers must be accredited to participate in competitive bidding, the prevailing assumption has been that suppliers would rush the doors of accrediting houses and that those houses would see spikes in the number of HMEs seeking accreditation. Some expected an Oklahoma Land Rush, but did anyone suspect the relatively lackadaisical approach to accreditation that unaccredited suppliers seem to be taking? "In terms of a spike, we haven't seen one," says JCAHO's Maryanne...