In brief: CMS provides timeline for wheelchair demo, offers competitive bidding webcast

Thursday, December 22, 2011

BALTIMORE - CMS last week announced the dates it plans to roll out the second phase, or the prior authorization, phase of its power mobility device (PMD) demonstration project. Those dates are: California, April 1; Illinois, Michigan and New York, June 1; and Florida, North Carolina and Texas, Aug. 1. Meanwhile, the HME industry continues to garner support for stopping or postponing the demo. Consumer and clinician groups, including the American Association of People with Disabilities, the National Council on Independent Living, the United Spinal Association and the Clinician Task Force have written to CMS Acting Administrator Marilyn Tavenner to voice their concerns. The industry continues to fight even as CMS seeks approval from the Office of Management and Budget (OMB) to collect prepay review information during the first phase of the demo, scheduled to begin Jan. 1. CMS's request was denied Dec. 19 because it was submitted under the wrong control number, industry sources say. At press time, the OMB hadn't answered the resubmitted request.

CMS offers competitive bidding webcast

WASHINGTON - CMS has posted "Welcome to Round 2 and National Mail-Order" on its website, an on-demand webcast that provides background information and data on educational resources available. CMS will issue more webcasts at a later date. CMS also reminded providers last week that registration for Round 2 of competitive bidding closes Feb. 9. Providers were "strongly urged" to register by Dec. 22. CMS posted a step-by-step guide to the registration process on

Pride Mobility hosts mentoring day

EXETER, Pa. - Pride Mobility Products and Quantum Rehab recently offered 28 students with disabilities an opportunity to be mentored by career professionals in various fields as part of its Disability Mentoring Day at is facility here. The mentoring day is designed to bring students and job seekers with disabilities into the workplace through hands-on career exploration, on-site job shadowing and ongoing mentoring, leading to internship and employment opportunities. "Directly showing students with disabilities that their futures aren't limited, but limitless, is a true privilege for those of us with disabilities who have sat in their seats, and gone on to inspiring, rewarding careers," stated Mark Smith, Pride consumer research manager, in a release. "

Global Medical is at it again

PHOENIX - Global Medical Equipment of America (GMEA) has acquired Bridgeport, Ohio-based Patriot Medical Supplies, it announced Dec. 19. In November, GMEA acquired Hospitality Oxygen & Medical Equipment in Palm Coast, Fla., and planned to open a satellite office in Tampa. Patriot Medical holds contracts with the Department of Veterans Affairs and various military facilities. "This service disabled certification will be expanded and allow Patriot Medical Supplies to become qualified suppliers with all federal and military locations," stated Harold Halman, president and CEO of GMEA, in a press release. Patriot Medical also serves its local community, offering a full line of DME, respiratory and mobility equipment, as well as some enteral and incontinence supplies.

Noridian clarifies leg rest billing

WASHINGTON - Noridian Administrative Services, the DME MAC for Jurisdiction D, issued an alert explaining the amount reimbursed for a center mount leg rest (K0108) on Dec. 13. The DME MAC stated it would reimburse the leg rest on the fixed price it has established based on the CMS instructed pricing methodology from directions in the Code of Federal Regulations Section 405.501 and 405.502. The two sections state that the charge Medicare pays must be reasonable and give criteria for reasonableness. 

Bi-level not appropriate for OSA

WASHINGTON - Recovery auditors have found that Medicare has been paying for a bi-level device (E0471) when the primary diagnosis was obstructive sleep apnea (OSA). In a message last week Noridian, the Jurisdiction D DME MAC, states that, according to the local coverage determination for PAP, E0471 is not reasonable and necessary if the primary diagnosis is OSA and will be denied by Medicare. Providers are advised to check the Respiratory Assist Devices LCD (l11493) for information on coverage, coding and documentation for the use of E0470 and E0471 for diagnoses other than OSA.

Infusion code guide published

ALEXANDRIA, Va. - The National Home Infusion Association (NHIA) on Dec. 21 released the 2012 version of the "NHIA National Coding Standard for Home Infusion Claims under HIPAA." The annual publication of procedures and claims examples is part of an effort to advance standardization of claim transactions and coding for home infusion services. It is available free of charge at

Graymark acquires another sleep lab

OKLAHOMA CITY - Graymark Healthcare has acquired a majority interest in Village Sleep Center in Plano, Texas, it was announced Dec 15. Graymark now operates a total of 100 sleep labs, including standalone facilities and hospital-based labs, nationwide. Graymark offers diagnostic and sleep therapy 


CMS selects "Pioneers"

BALTIMORE - Thirty-two healthcare organizations from across the country will participate in the Pioneer Accountable Care Organizations initiative, HHS Secretary Kathleen Sebelius announced Dec. 19. Under this initiative, Medicare will reward groups of healthcare providers that have formed accountable care organizations (ACOs) based on how well they improve patient health and lower healthcare costs. It is estimated the Pioneer initiative could save up to $1.1 billion over five years. For a list of participating healthcare organizations go here.