In brief: CMS considers MA audits, CPAP startup gets funding

Thursday, December 31, 2015

WASHINGTON – CMS is considering expanding its RAC program for Medicare Advantage, according to a draft scope of work published by the agency.

Currently, CMS audits 30 MA contracts per payment year, about 5% of the total number of contracts. Now it is considering increasing the number of contracts that are subject to some type of risk adjustment data validation audit, which validates the accuracy of diagnosis data submitted by MA organizations.

“Our ultimate goal is to have all MA contracts subject to either a comprehensive or condition-specific RADV audit for each payment year,” the agency states in the draft.

Errors and omissions in diagnosis data submitted by MA organizations are the drivers of the 9.5% improper payment rate in Medicare Part C, according to CMS.

The Patient Protection and Affordable Care Act of 2010 requires expansion of the RAC program to Medicare Part C and Part D, the agency states.

CMS is accepting comments on the draft until Feb. 1.

Sutter Home Care expands footprint in California

FAIRFIELD, Calif. – Sutter Home Care, whose offerings include HME, respiratory therapy and home infusion, has acquired Alliance Home Health. Fairfield, Calif.-based Sutter Home Care delivers care to more than 150,000 patients in 24 counties in Northern California. Alliance Home Health offers skilled nursing, OT and PT, speech therapy, and home health aide and medical social services to patients in Monterey County. “Our partnership with Alliance Home Health will expand Sutter Care at Home’s capacity to provide timely, affordable and high-quality home health services in Monterey County,” stated Marcia Reissig, CEO of Sutter at Home. “Our mutual goal is to further expand and strengthen home health services in the community.”

Tubeless CPAP mask draws $500K in funding

BURLINGTON, Mass. – Startup Airing has received $500,000 in funding to commercialize its disposable, tubeless CPAP mask, according to Boston Business Journal. The funding follows a successful crowdfunding campaign in July that raised $100,000 in three hours and has netted more than $1.1 million to date by offering vouchers to buy the mask at a steep discount when (and if) it becomes available. Airing plans to retail the masks for $3. The recent funding, from a single investor, is part of a larger goal to raise $2.5 million, according to the journal.

Z1 Auto CPAP gets upgrade

CHARLOTTESVILLE, Va. – Human Design Capital has released a firmware upgrade for its Z1 Auto CPAP machine and Nitelog App for Android devices. The upgrade delivers a new Z-Breathe algorithm with settings that offer more breathing comfort, improved battery life and quieter operation, according to a press release. The upgrade also allows users to sync the Nitelog App with the latest Android software version 5.1.1. The app syncs with the Z1 via Bluetooth to display sleep therapy results, including apnea/hypopnea index, apnea count, usage hours and pressure levels in day-week-month presentations. HDM is owned by Charlottesville, Va.-based PBM Capital.

President signs complex rehab bill into law

WASHINGTON – President Obama signed the Patient Access and Medicare Protection Act into law last week, delaying the application of competitive bid pricing to accessories used on Group 3 complex power wheelchairs for one year. “Our recommendation is to hold off on billing any claims for Group 3 power wheelchair accessories with dates of service on or after Jan. 1, 2016, until this CMS guidance is received,” wrote Don Clayback, executive director of NCART, in an email to members. Unfortunately, the one-year delay does not apply to accessories used with complex rehab manual wheelchairs, which will be paid at competitive bid rates starting Jan. 1. “We will be working on solutions to this issue as part of our activities in early 2016,” added Clayback.

Infusion scholarship deadline approaching

ALEXANDRIA, Va. – The National Home Infusion Association is accepting applications for two scholarships. The Lynn Giglione Memorial NHIF Scholarship Award for Home and Specialty Infusion Nursing and the inaugural Scholarship for Excellence in Home and Specialty Infusion Pharmacy Practice are open to nurses and pharmacists who have demonstrated a commitment to advancing patient care, says NHIA in a release. Each scholarship offers complimentary registration to the association’s 2016 annual conference, scheduled for March 21-24, 2016, in New Orleans, and an allowance of $1,500 for travel, hotel, and incidentals. Scholarship applications are due Jan. 15.