In brief: CMS limits certain audits, F2F gets easier

Friday, April 24, 2015

BALTIMORE – Wave goodbye to audits of older claims for DME supplied to Medicare beneficiaries during a Part A stay.

After working with AAHomecare, CMS has issued a “technical direction letter” to the recovery audit contractors advising them to limit audits to those claims paid on or after April 1, 2015, the association stated in a bulletin.

“By presenting the facts instead of being guarded, we’re building credibility and trust, and this type of collaborative discussion is the result of that,” said Kim Brummett, vice president of regulatory affairs at AAHomecare. “CMS heard us, and within a matter of weeks, we had a common sense fix that will provide significant relief to suppliers.”

Because the RACs have been auditing older claims, providers have been unable to re-file claims due to the timely filing requirement.

A new process for handling these claims, called an informational unsolicited response, will be implemented for dates of service starting April 1, 2015. As part of the new process, the RACs will automatically compare DMEPOS claims paid to Part A claims. If a DMEPOS claim has been paid where the from date of service is during the Part A stay, the payment will be automatically recouped.

AAHomcare advises providers to monitor their electronic remittance notices and, when a recoupment is made, do research to determine when the patient was in Part A stay and submit amended claims post-discharge if the patient had continued to use the equipment/supplies.

F2F requirement gets easier

WASHINGTON – The recently passed “doc fix” bill includes a provision that expands who can conduct the face-to-face exam required for DME. The provision modifies the requirement to allow physicians, physician assistants, practitioners, or specialists to conduct the exam. Industry stakeholders have long held that limiting who can document the face-to-face exam to physicians would result in delays in equipment and services. CMS implemented the face-to-face requirement on July 1, 2013, but it hasn’t started enforcing the requirement yet, some say, because the agency has also been waiting for Congress to make this change. CMS also implemented the written order prior to delivery requirement on July 1, 2013, and it started enforcing the requirement on Jan. 1, 2014.

Invacare sells, then leases back, properties

ELYRIA, Ohio – Invacare has secured $23 million in a sale and leaseback transaction. The company has sold and leased back under long-term leases five of its properties located in Ohio and Florida. The net proceeds from the transaction will be used to reduce debt on the company’s revolving asset-based credit facility, according to a press release. ''We are pleased that we have completed this sale and leaseback transaction, which is part of our ongoing plan to proactively manage cash and debt in our current environment,” stated Matthew Monaghan, president and CEO, in a press release. “This transaction will not affect our day-to-day operations, but it does allow us to strengthen our balance sheet and address the current cash needs of the business.” The total annual rent for the properties will be $2.275 million for the first year and will increase annually over the 20-year term of the leases based on the applicable geographical consumer price index.

Univita expands telehealth programs

MIRAMAR, Fla. – Univita Health has expanded its Re-admission Reduction Solution and Hospital to Home programs in the Orlando metro area. The two programs use telehealth and specially trained nurses to reduce readmissions among high-risk patients with heart failure, COPD, diabetes and kidney disease, according to a release. The Re-Admission Reduction Solution resulted in an 81.8% reduction in readmissions for one health plan, according to a study. “We estimate that by avoiding these unnecessary re-admissions, the health plan in the study saved an estimated $54,000 annually per patient and, more importantly, helped their members stay out of the hospital and remain in the comfort of their own home while improving their outcomes and quality of life,” said Dr. Victor Valdes, executive vice president of clinical innovation at Univita.

OIG: CMS overpays for infusion drugs

WASHINGTON – CMS could have saved $251 million over an 18-month period if it paid for DME infusion drugs using an average sales price methodology, according to a new report from the Office of Inspector General. While most Part B drugs are paid at 106% of the ASP, infusion drugs are paid at 95% of the average wholesale price. Between the second quarter of 2013 and the third quarter of 2014, at least 42% of infusion drugs were paid at amounts that were more than twice their estimated acquisition costs, the report says. The OIG recommends that CMS either seek a legislative change requiring infusion drugs to be paid using ASP, or include the drugs in the next round of competitive bidding. CMS partially concurred with the first recommendation and concurred with the second.

NASDAQ puts Inogen on notice

GOLETA, Calif. – Inogen has received a notice from the NASDAQ stating it’s not in compliance with a rule requiring timely filing of periodic financial reports with the Securities and Exchange Commission. Inogen received the notice on April 15 after failing to file its Form 10-K for the fiscal year ended Dec. 31, 2014, on two separate occasions. “The NASDAQ notice has no immediate effect on the listing or trading of Inogen’s common stock on the NASDAQ Global Select Market,” the company stated in a press release. “Under NASDAQ rules, Inogen has 60 calendar days from the date of the letter to submit a plan to regain compliance.” Inogen announced March 12 that it would not meet the March 31 deadline for filing the form due to an internal investigation into its accounting practices. The company announced on April 1 that it filed a Form 12b-25 to get an extra 15 days to file the form, but then it announced April 14 that it still wasn’t ready. If the NASDAQ approves Inogen’s plan to regain compliance, the company will have until Oct. 12, 2015, to file the form. “Inogen expects to submit a plan to regain compliance or file its Form 10-K within the timeline prescribed by NASDAQ,” the company stated. Inogen says documentation issues are to blame for the delay in filing.

Moneyline: Respira, InfuSystem

Linthicum, Md.-based Respira has acquired Respiratory Therapy Associates of PA, expanding its reach in the mid-Atlantic region. Respiratory Therapy Associates services Pennsylvania and Delaware. The acquisition also allows Respira, primarily a sleep and respiratory therapy company, to expand into long-term care, ventilation and hospice care. Respiratory Therapy Associates is now part of a Respira umbrella that includes Respira Medical, which provides sleep, respiratory and HME services to civilians; Respira Medical Military, which provides care to the Armed Forces and Department of Defense; and Respira Technical Services, which develops and manages safety and health planning for the U.S. Strategic Petroleum Reserves for the Department of Energy. Chuck Ciccone, the president of Respiratory Therapy Associates, is now vice president of Respira. The acquisition increases Respira’s employee rolls from 60 to about 100…Madison Heights, Mich.-based InfuSystem, a national provider of infusion pumps and services, has acquired the assets of Alpharetta, Ga.-based Ciscura. Per the deal, InfuSystem will acquire about 1,600 infusion pumps, a four-person sales team, and facilities management personnel. The company will establish a new Southeast facility near Atlanta.

Glucose testing supplies have 99% error rate

YARMOUTH, Maine – National Government Services, the DME MAC for Jurisdiction B, conduced a widespread prepayment probe review of glucose testing supplies (A4253KX) between Oct. 22 and Jan. 1 and found all but one of 100 claims were denied. The top reasons for denials were: no medical records were submitted; the proof of delivery record did not include the beneficiary signature; the detailed written order did not include a physician signature that complied with CMS’s signature requirements; the proof of delivery record did not include the delivery address; no documentation to support the specific reason for additional materials; and refills of quantities of supplies that exceed the utilization guidelines were dispensed with no documentation within the past six months that the beneficiary is testing at a frequency that corroborates the quality of supplies that have been dispensed.

Short takes: 101 Mobility, Buffalo Wheelchair, 3B Medical

101 Mobilityrecently joined VetFran, a network of franchise brands that offers benefits to aspiring veteran franchisees and employees. The Wilmington, N.C.-based provider will offer a $5,000 discount on its franchise fee to qualified military veterans…Buffalo Wheelchair has opened a retail location. Buffalo Home Medical Supply offers bath safety, bracing and other DME items…Advance Home Care Supply now offers delivery of adult incontinence products. The Southfield, Mich.-based provider will allow customers to enroll in automatic delivery for 5% off every order…3B Medical has received 510K FDA clearance for its Luna Positive Airway Pressure Platform. The Luna offers remote compliance monitoring and QR coding…HME providers in North Carolina met with Republican Sen. Richard Burr’s office this week to discuss Medicare issues like competitive bidding and audits, and their impact on providers and beneficiaries…Philadelphia-based BurmansRx has been recognized as a 2015 Philadelphia Smart CEO Family Business. The award honors family businesses that are growing and successful, according to a press release…Atlanta-based GF Health Products has received a flag that was flown over the U.S. Capitol Building in recognition of its efforts to manufacture products in the U.S. The company, which has three manufacturing facilities in Doraville, Ga., Fond du Lac, Wis., and Hazelwood, Mo., received the flag from Rep. Tom Price, R-Ga.