In brief: CBIC seeks ‘substantiation’ letters, Apria responds to wildfires

Friday, November 8, 2019

WASHINGTON –The Competitive Bidding Implementation Contractor has sent notices to bidders asking them to substantiate their bids, VGM reports.

Most or all bidders in the non-invasive vents category have received requests, which ask bidders to ensure they are able to furnish the items to beneficiaries with a profit at the rate they bid.

Failure to respond, or if the information provided does not support the bid, will result in disqualification.

Providers who receive requests must provide a narrative that explains how they arrived at their bid amount, including product cost, indirect costs, anticipated utilization of non-lead items and desired profit; and supporting documentation, including invoices, receipts, letters of intent from manufacturers and wholesalers, manufacturer price lists and signed written quotes.

The deadline to respond is Nov. 14.

Bid survey

CMS is accepting comments on how to effectively communicate with referral agents, as they “play a critical role in assisting beneficiaries in obtaining competitive bid items,” said CMS officials during an Open Door Forum on Nov. 6. These comments are used to strengthen the monitoring, outreach and enforcement functions of the DMEPOS competitive bidding program. To submit a comment, email dmepos@cms.hhsgov and put “competitive bidding surveys” as the subject line. The deadline to submit comments is Dec. 20.

Apria Healthcare responds to wildfires

LAKE FOREST, Calif. – Apria Healthcare has launched a mobilized effort to deliver critical equipment to its patients in California, where wildfires continue to plague much of the state.

The provider says its employees have been working around the clock to ensure equipment like oxygen tanks are being delivered. Last week alone, they made more than 20,000 deliveries, with trucks set up in strategic locations to help distribute equipment to patients being evacuated from their homes.

“Our employees have been working nonstop, even while some of their own families were without power or had been evacuated from their homes,” said Zachary Holt, general manager of the Apria Santa Rosa branch. “This truly speaks to the unwavering dedication and commitment we feel toward our patients and communities.”

In advance of power outages meant to prevent the wildfires, local branches were already proactively filling up delivery vans, making calls to distribution centers to ensure adequate inventory and individually calling hundreds of patients.

Scared and frustrated patients have been relieved by Apria’s efforts, the company says.

“Our patients have been able to stay home and get their equipment delivered instead of having to travel to a local hospital for oxygen,” said Tyler Hutton, general manager of the Apria Eureka branch office.

OIG to CMS: Adjust payments for orthotic devices

WASHINGTON – Medicare allowable amounts for certain orthotic devices are not comparable with payments made by select non-Medicare payers, according to the Office of Inspector General.

For calendar years 2012-15, the OIG estimated that Medicare and beneficiaries paid $341.7 million more than select non-Medicare payers on 142 HCPCS codes and $4.2 million less than select non-Medicare payers on 19 codes. Of the net $337.5 million difference, the agency estimated that Medicare paid $270 million and beneficiaries $67.5 million.

The reason, according to the OIG: CMS does not routinely evaluate pricing trends for orthotic devices or payments made by select non-Medicare payers; instead, it uses statutorily mandated fee schedule payments that have an economic update factor applied to them annually.

The OIG identified 95 codes for which the Medicare allowable amounts could be adjusted using existing legislative authority to make those amounts comparable with payments made by select non-Medicare payers. For the remaining 66 codes, CMS would be required to seek new legislative authority to make adjustments.

The OIG recommends that 1) CMS review the allowable amounts for the 161 codes for which Medicare and beneficiaries paid more and adjust the allowable amounts, as appropriate, using regulations promulgated under existing legislative authority or, if that’s not possible, seek authority to align Medicare allowable amounts for these items; and 2) routinely review Medicare allowable amounts for new and pre-existing orthotic devices to ensure that Medicare allowable amounts are in alignment with payments made by select non-Medicare payers or pricing trends.

CMS concurred with the OIG’s recommendations, saying it would consider recommending this proposal for inclusion in the president’s next budget. The agency also noted that it has included a new methodology for calculating fee schedule payment amounts for new DMEPOS as part of a recent final rule.

Stockholders green light DFB, AdaptHealth merger

NEW YORK – DFB Healthcare Acquisitions stockholders have voted to approve all of the proposals related to its merger with AdaptHealth Holdings. The company’s board of directors previously approved the combination and recommended that stockholders do the same. Stockholders also approved proposals to: change DFB’s name to AdaptHealth and remove certain provisions related to DFB’s status as a blank check company; issue certain securities for complying with applicable listing rules of the Nasdaq Capital Market; approve the AdaptHealth stock incentive plan and employee stock purchase plan; and elect seven directors to the board (Richard Barasch, Alan Quasha, Terence Connors, Dr. Susan Weaver, Dale Wolf, Luke McGee and Joshua Parnes). Following the close of the merger, the combined company’s Class A common stock and warrants will continue to be listed on the Nasdaq under the ticker symbols “AHCO” and “AHCOW,” respectively.

Ventec connects VOCSN

BOTHELL, Wash. – Ventec Life Systems, the manufacturer of the VOCSN multi-function ventilator, has launched VOCSN Multi-View to provide patient trending and monitoring across multiple therapies. Mult-View is designed to summarize patient data and create trend reports to facilitate actionable and informed treatment decisions and care plans, drive proactive interventions, control costs and deliver seamless care across providers from hospital to home, company officials say. “Multi-View now provides relevant data for caregivers to make informed treatment decisions in a way that’s never been possible,” said Chris Kiple, CEO. “Integrated reporting opens a new chapter in respiratory care that we believe will lead to customized patient treatment plans, better health outcomes and more cost-effective patient care.” Ventec has partnered with Bridge-Tech Medical to ensure that data from VOCSN is transmitted in a secure, anonymized format. The company will make Multi-View available in November through Multi-View Beta, with a formal launch scheduled for 2020. It will offer two compatible platforms: Multi-View Home and Multi-View Hospital. Ventec launched VOCSN last year.

Are you ready to bill with MBIs?

ATLANTA – Providers must use Medicare Beneficiary Identifiers when billing Medicare beginning Jan. 1, 2020, the van Halem Group reminds them in a recent blog. The Medicare Access and CHIP Reauthorization Act of 2015 required CMS to remove Social Security Numbers from all Medicare cards by April 2019. CMS replaced SSN-based HCINs with new randomly generated MBIs. On Aug. 19, CMS reissued an MLN Matters article to show that all new Medicare cards have been mailed out and to encourage providers to use MBIs. “Use MBIs now for all Medicare transactions,” the blog states. The van Halem Group recommends that providers: ask Medicare patients for their new Medicare cards when they come in for care, use their MAC’s secure MBI lookup tool, and check remittance advice for MBIs and save them.

J & B Medical buys into virtual model of care

SCOTTSDALE, Ariz. – J & B Medical, a provider of consumable medical products, and its subsidiary HNC Virtual Solutions have joined forces with Lif365 to create a new virtual model of care. J & B Medical and HNC Virtual Solutions are joining American Medical Response and Life365 to offer new integrated virtual care solutions to several large providers and payers across the country. “We believe that being integrated in the Life365 Platform enables us to offer providers with a wider range of goods and services—cafeteria style—bringing more value to them and their members with a more personalized offering,” said Stephen Shaya, M.D., of J & B Medical. Life365 is an interoperable, scalable, multi-channel Integrated Health Platform that facilitates solution and service deployment for healthcare systems addressing self-managed patient care at home.

Insulet raises full-year outlook

ACTON, Mass. – Insulet Corp. reported revenue of $192.1 million for the third quarter of 2019 compared to $151.1 million for the same period in 2018, a 27% increase. Global Omnipod revenue was $177.2 million, a 34% increase. Of that, U.S. Omnipod revenue was $109.5 million, and international Omnipod revenue was $67.7 million, up 34% and 35%, respectively. The company reported gross margin of 64.1% and operating income of $17 million. "Consistent execution of our strategic imperatives combined with Insulet's strong foundation will fuel our continued growth,” said Shacey Petrovic, president and CEO. “We are raising our outlook for the full year 2019 and will continue to drive growth and value creation over the long term. Our team is focused on delivering life-changing innovation to people living with diabetes around the world." For the year ending Dec. 31, Insulet is raising its revenue guidance to between $722 million and $730 million, representing growth of 28% to 29%, previously 24% to 27%).

ACHC launches home infusion accreditation program

CARY, N.C.  – The Accreditation Commission for Health Care has launched a Home Infusion Therapy Accreditation Program. The new program looks at education assessment, medication review and the development of a plan of care provided by a nurse or healthcare professional during a home visit. Standards are similar to those for ACHC’s infusion nursing and private duty infusion nursing services. "ACHC is dedicated to ensuring the highest-quality patient care as demands for home infusion therapy services continue to grow," said Susan Mills, ACHC associate clinical director. "Our standards were designed to meet new accreditation requirements while preserving the value of home infusion therapy services and helping providers enhance the quality of services they provide." Per the 21st Century Cures Act, home infusion suppliers must be accredited to receive Medicare reimbursement.

Walgreens to offer Dexcom G6 to Medicare patients

DEERFIELD, Ill. – Walgreens is launching a new billing solution to allow Medicare beneficiaries who use the Dexcom G6 continuous glucose monitoring system to fill their prescription at any of its more than 9,200 retail locations. Currently, the devices are filled through DME suppliers, manufacturers or limited pharmacies. Walgreens is also working with other CGM manufacturers to incorporate their products into the new billing model. “Leveraging Walgreens nationwide footprint and our expertise in providing medical billing solutions, we’re able to deliver a unique combination of personalized care and streamlined processes, making it easier for physicians and patients to prescribe and fill the Dexcom G6 at our stores,” said Rick Gates, senior vice president of pharmacy and healthcare. “This builds on Walgreens commitment to providing innovative solutions to simplify the customer experience and support patients managing chronic conditions, like diabetes.”

The Netflix effect: Adults give up sleep to binge-watch

DARIEN, Ill. – A “whopping” 88% of American adults have lost sleep due to binge-watching a TV show or streaming series, according to the result of a new survey from the American Academy of Sleep Medicine.

For 18-44 year olds, that number jumps to 95%.

Other causes of lost sleep, according to the survey:

·      Video games for 72% of adults 18-34 years old;

·      Reading for two-thirds of adults, with women the majority (71%);

·      Watching sports for 60% of adults, with men the majority (75%). Additionally, for 25-54 year olds, 54% were more likely to stay up for overtime or extra innings.

On the bright side, adults rank sleep as their No. 2 priority after family, says AASM.

"It’s encouraging that Americans rank sleep as one of their highest priorities, but choosing to binge on entertainment at night instead of sleeping has serious ramifications,” said AASM President Dr. Kelly A. Carden. “Sleep is essential to health, well-being and safety, and chronic insufficient sleep can lead to an increased risk of health problems, mood disorders and motor vehicle accidents.”

NHIA on final rule: Association criticizes ‘outdated notions’

ALEXANDRIA, Va. – The National Home Infusion Association is “disappointed” by CMS’s recently released ESRD final rule, which, among other things, finalizes payment provisions for home infusion therapy services beginning in 2021. The association objects to the agency’s plan to limit reimbursement for professional services to only those days that “skilled professionals”—defined as nurses—are in the home. “The recently published home infusion rule continues to reflect outdated notions regarding the critical role pharmacists play in creating patient access to home-based infusion services,” said Connie Sullivan, president and CEO of NHIA. “The NHIA stands ready to work with members of Congress to enact legislation that will create a Medicare home infusion benefit that brings the same efficiency, choice and success that patients enjoy in the private sector.”

Itamar’s WatchPAT gets nod from Blues

CAESAREA, Israel – Itamar Medical has received coverage for its WatchPAT as a home sleep apnea diagnostic test by Blue Shield of California (BSC) and the Blue Cross Blue Shield Federal Employee Plan (BCBS FEP). The inclusion of WatchPAT and PAT technology follows an assessment, Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome, recently released by Blue Cross Blue Shield Association Evidence Street. “The inclusion of WatchPAT as a recommended test for sleep apnea in the BCBS Evidence Street assessment is an important validation of the clinical value that Itamar’s PAT technology provides,” said Gilad Glick, president and CEO. The company also noted the release of the Medicare 2020 Fee Schedule, which it says contains changes to home sleep apnea diagnostic coding that should support and expand the use of WatchPAT technology.

OIG criticizes supplier documentation for inhalation drugs

WASHINGTON – Not all suppliers comply with Medicare requirements when billing for inhalation drugs, according to the Office of Inspector General. For 81 of the 120 sampled claim lines, suppliers complied with requirements; for the remaining 39 claim lines, 22 suppliers did not comply with requirements. The OIG says the documentation from these suppliers contained incomplete, invalid or missing detailed written orders; incomplete proof of delivery; incomplete refill requests; and no medical records. The agency estimates that, on the basis of this sample, Medicare wrongly paid $92.5 million to suppliers. The OIG recommends that CMS instruct the Medicare contractors to recover nearly $37,000 in overpayments for the 39 unallowable claim lines and notify the 22 suppliers associated with these claim lines of the potential overpayments so that they can investigate and return any identified overpayments. It also suggested CMS work with Medicare contractors to expand their review of inhalation drug claims and provide additional training.

Virtue Technologies gets buy in from PE firm

MURFREESBORO, Tenn. – Virtue Technologies, a provider of post-acute healthcare technology solutions, has received an investment from Claritas Capital, a Nashville, Tenn.-based private equity firm. Virtue Technologies, created out of a joint venture between TwelveStone Health Partners and VirtueRN, says it addresses the fragmented market for communicating orders for medical equipment and medications to service providers and patients. “The delivery of post-acute care can often be quite challenging,” said Gibran Ameer, CEO of Virtue Technologies. “Technology is a means to un-complicate and simplify business processes—our solutions do just that. This results in a positive impact to operational efficiencies, costs, revenue cycle and, ultimately, a better patient experience.” TwelveStone Health Partners and VirtueRN joined forces to form Virtue Technologies in early 2018. Previously, TwelveStone received a $4.3 million investment from Claritas Capital last year to fuel expansion efforts for its packaged pharmacy, infusion center and technology platform business lines. It also received a $3.35 million investment from the PE firm in 2017.

VGM calls for speakers

WATERLOO, Iowa – VGM Group is now accepting proposals from prospective speakers for its annual Heartland Conference. The company is looking to fill eight education tracks with sessions on everything from business leadership and management, to retail, to sales and marketing, to technology. “For presenters, the Heartland Conference isn’t short on opportunity,” said Jill Blaser, chairwoman of Heartland Education. “It’s the perfect place to have one-on-one time with members and vendors, other presenters and, of course, everyone at VGM. Presenters are in the unique position to introduce, or reintroduce, themselves to the HME community and leave an outstanding impression.” The conference takes place June 15-17 in Waterloo, Iowa. Proposals are due Dec. 16. Interested speakers can fill out an online form at

New real estate: Inogen consolidates in Texas

EAST PLANO, Texas – Goleta, Calif.-based Inogen has signed a 10-year lease on 154,097 square feet of industrial and office space in East Plano, Texas, according to D Magazine, a commercial real estate publication. The company currently occupies two industrial buildings and one call center in Richardson, Texas, but it will now consolidate everything under one roof in East Plano. Inogen will use about 90,000 square feet of the space for manufacturing operations and the remaining roughly 60,000 square feet for a call center. The company plans to occupy the space in early 2020.