In brief: CMS posts FAQ on prior auths, Lincare must pay penalty

Friday, February 5, 2016

WASHINGTON – CMS has published an FAQ for the prior authorization process for DME. A number of the questions address the agency’s “master list” of 135 products for which a prior authorization could be required. Those products include CPAP devices, semi-electric hospital beds, manual wheelchairs and oxygen concentrators. Stakeholders are still waiting for sub-regulatory guidance on when prior authorizations will be required and for what products. CMS published its final rule for the prior authorization process on Dec. 30, with an effective date of Feb. 29.

ALJ sides with feds, Lincare must pay $240K penalty

CLEARWATER, Fla. – Lincare will pay nearly $239,800 in civil monetary penalties for violating the Health Insurance Portability and Accountability Act, a U.S. Department of Health and Human Services Administrative Law Judge ruled Feb. 3. This is only the second time in its history that the Office for Civil Rights has sought civil monetary penalties for HIPAA violations. Each time, the penalties have been upheld by the ALJ. OCR’s investigation of Lincare began after an individual complained that a Lincare employee left behind documents containing the protected health information of 278 patients after moving residences. OCR found that this employee removed protected health information form the company’s office, left the information exposed in places where an unauthorized person had access to it and then abandoned the information altogether. OCR found that Lincare had inadequate policies and procedures in place to safeguard patient information that was taken offsite. “Although aware of the complaint and OCR’s investigation, Lincare subsequently took only minimal action to correct its policies and strengthen safeguards to ensure compliance with the HIPAA rules,” HHS stated in a release. Lincare claimed it had not violated HIPAA because the patient information was “stolen” by the individual who discovered it on the premises previously shared with the Lincare employee. The ALJ rejected this argument, agreeing with OCR that under HIPAA, Lincare was obligated to take reasonable steps to protect its patient information from theft.

VGM offers playbooks

WATERLOO, Iowa – The VGM Group has made available a 26-page playbook with ideas and strategies to grow and adapt in this new age of HME. The 2016 HME Business Playbook addresses market and healthcare trends, new business and revenue opportunities, product life-cycle economics, among other topics. “This resource is truly a game-changer for our industry,” said Clint Geffert, president of VGM & Associates. “Similar to sports, in business you need to research ways to take advantage of the match-up or situation to have success.” There are three versions of the playbook for providers in bidding, rural, and regional areas. VGM plans to update the playbooks each quarter. Other topics that will be addressed include cybersecurity, healthcare retail, home modifications and business analytics. “The landscape for HME has and will continue to change and that’s precisely why our team of experts works relentlessly to develop programs to take on and assist our members with their toughest business challenges.” The playbook is free and available to members and non-members.

Cape Medical Supply reimagines CPAP experience

SANDWICH, Mass. – Cape Medical Supply will roll out a “Visual Learning Program” for all new CPAP patients on Feb. 15. The program uses iPads, visual instructions and hands-on training with CPAP machines to show patients how to set up, use and diagnose common problems with their sleep therapy. “In the summer of 2015, we began a very detailed study of what we call the ‘PAP Patient Experience,’” said Mike Sheehan, COO. “We felt the setup process was far too wordy and in an effort to help patients absorb important aspects of their therapy, we decided to pair the verbal approach with images, videos and easy-to-understand instruction packets.” Cape Medical Supply anticipates that the program will improve the company’s already industry-leading compliance rate and help patients adjust to their therapy faster. The program is only the latest improvement Cape Medical Supply has made to its sleep therapy program since 2012. Other recent improvements include an online reordering portal called MyResupply, online payment portals called AutoPay and BillPay, a Sleep Therapy Center in Sandwich, and SleepExpress locations in New Bedford and Plymouth.

Golden, VGM boost retail offerings

OLD FORGE, Pa. – Golden Technologies and The VGM Group have joined forces to further focus the HME industry on maximizing retail sales. “Ultimately, this partnership will be instrumental in leading the industry’s dependency away from the reimbursement model,” said Richard Golden, president and CEO of Golden Technologies, in a press release. The two companies, long-time proponents of retail in the HME industry, will embark on a nationwide tour, including the Heartland Conference in June, to train providers on branding and merchandising. Golden will also bring to the table its “business process modeling” for retail. “It has been proven that the most effective DME model is all about showing retailers the critical importance of focusing on selling prices,” said C.J. Copley, executive vice president of sales and marketing at Golden Technologies. “By focusing on business process modeling for retail, including bundling sales, GMROI, revenue per square foot, daily customer traffic and cost per sales, retailers can increase the average ticket selling price.” Golden gives a nice boost to the offerings and business solutions that VGM offers its members. “We look forward to this new partnership with Golden Technologies to further enhance retail solutions for our members,” said Clint Geffert, president of VGM & Associates.

Breas Medical celebrates 25 years

CHARLOTTESVILLE, Va. – Breas Medical, an affiliate of PBM Capital Group, a healthcare-focused investment firm based here, celebrates 25 years in business this year. The Gothenburg, Sweden-based Breas manufactures the Vivo homecare ventilation range and the iSleep CPAP and bi-level sleep therapy products. In its 25th year, Breas plans to launch multiple products and to grow globally, it says. PBM, which also owns Human Design Capital, maker of the Z1 portable CPAP device, and B&D Electromedical, bought Breas from GE Healthcare in 2014.

MK Battery makes executive changes

ANAHEIM, Calif. – MK Battery has appointed Rick Spiegel as vice president of sales. Spiegel, a 15-year veteran of the company with more than 25 years of experience in HME, was most recently vice president of operations. He also oversaw the company’s global OEM sales functions. Spiegel’s predecessor, David Brunelle, has transitioned to another division of the company. In another move, MK Battery has named Jeff Pitzer director of operations. He joined the company in 2004 and was most recently director of service & logistics.

Congress seeks to eliminate barriers to telehealth

WASHINGTON – The Senate introduced a bill Feb. 2 that would lay the groundwork to expand Medicare reimbursement for telehealth services, according to Bloomberg. The bill, S. 2484, would create a program that would waive for participating providers Medicare’s requirements that telehealth services occur at a qualified site and other restrictions. The House of Representatives introduced an identical bill Feb. 3. The “bridge program” would require participating providers to submit annual reports to the Department of Health and Human Services on how their expanded use of telehealth affected their bottom lines. These reports would be used to prove that telehealth could reduce Medicare spending under the Merit-Based Incentive Payment System, according to Bloomberg.

Consumers want to monitor their health, survey finds

REDWOOD CITY, Calif. – More than eight out of 10 consumers believe that tracking their own health data with a clinically accurate monitoring device will help improve their overall health, according to a national survey of 1,000 respondents commissioned by The Society for Participatory Medicine and healthcare technology company Biotricity. Fifty-seven percent of consumers say they would wear monitoring devices for personal use and they would share the data those devices collect with healthcare professionals, the study found. “Increasingly, patients are actively monitoring their own health data to better self-manage their chronic diseases and collaborate with their healthcare professionals,” stated Daniel Sands, MD, MPH, co-founder and co-chair of the Society of Participatory Medicine and a practicing physician. “Self-monitoring is vital component of an efficient and high-functioning healthcare system. This survey shows that this concept resonates with the public and that most respondents are willing to utilize technology to gather this data to improve their health.” Biotricity is focused on delivering biometric monitoring solutions for medical, health care and consumer use.

Disability group launches capital campaign

STONE MOUNTAIN, Ga. – Friends of Disabled Adults and Children (FODAC), which will be an exhibitor at the upcoming Medtrade Spring, has launched a campaign to raise $1.5 million by the end of 2016. FODAC will apply the funds toward facility upgrades and paying off the mortgage on its corporate headquarters. “This campaign will help FODAC better leverage HME donations across the state for the benefit of the community,” said CEO Chris Brand. The nonprofit, which celebrates its 30th anniversary this year, provides more than $10 million annually in HME and supplies to those living with disabilities. The goal of the “Keeping People with Disabilities Moving Campaign” is to improve FODAC’s effectiveness in three ways: warehouse and product flow improvements, facility improvements, and financial improvements.

Short takes: ResMed, OMHA, NCART, Great Lakes

ResMedhas completed its acquisition of Inova Labs, officially making it a player in both the sleep and oxygen therapy markets…The Office of Medicare Hearings and Appeals will host the fourth Medicare Appellant Forum via webinar/teleconference on Feb. 25 from 1 p.m. to 4 p.m. It plans to discuss updates on steps that it and the Department of Health and Human Services are taking to address a huge backlog at the administrative law judge level of the appeals process. OMHA last held a forum in June 2015…Long-time complex rehab advocate Finn Bullers passed away on Jan. 30 from complications of an illness, according to NCART. Bullers, who was named Advocate of the Year in 2014 by the United Spinal Association, was 52…Great Lakes Caring Home Health and Hospice has made changes to its leadership team, naming Adam Nielsen as president; Marcy Miller, RN, as chief clinical officer; and Carry vandenMaagdenberg as CIO. William Deary will remain CEO.