In brief: CMS releases guidance on bid-rate relief, OIG updates Medicare market shares for diabetes test strips

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Friday, February 10, 2017

WASHINGTON – Suppliers won’t need to resubmit claims to get retroactive payment adjustments mandated by the 21st Century Cures Act, according to guidance released Feb. 9 by CMS.

The Cures Act, signed into law in December, rolled back cuts that went into effect in non-competitive bidding areas from June 30, 2016, to Dec. 31, 2016, allowing providers in those areas to recoup six months worth of payments.

In guidance released to the DME MACs, CMS said it will recalculate the fee schedule to extend the 50/50 blended fee schedule in effect from the Jan. 1 to June 1, 2016, timeframe to the July 1 to Dec. 31, 2016, timeframe, according to a bulletin from AAHomecare.

The revised fee schedule will be available to the DME MACs on or after May 1, 2017. The DME MACs can start processing affected claims as soon as the revised schedule–expected to be available May 1—is loaded into their systems.

Suppliers don’t need to submit new claims or other materials. Instead, the DME MACs will create a one-time process to validate and adjust claims, and will automatically perform a mass reprocessing of claims. Suppliers who believe that their claims weren’t reprocessed will then need to submit a request.

OIG updates Medicare market shares for diabetes test strips

WASHINGTON – Suppliers in Medicare’s national mail-order program provided 18 types of diabetes test strips to beneficiaries from July through September 2016, according to a new report from the Office of Inspector General.

The top strip type accounted for 43% of the mail-order market, and the top 10 strip types accounted for 98% of the market, the OIG found.

The OIG conducted its report by sampling 1,210 claims from a population of 456,784 claims for mail-order test strips.

Suppliers must comply with a rule outlined in the Medicare Improvements for Patients and Providers Act (MIPPA) that they provide at least 50% (by volume) of the types of test strips provided to beneficiaries. The OIG states suppliers could comply with this rule by committing to provide at least two strip types.

This is the second of three reports from the OIG to determine the market shares of diabetes test strips for the periods April through June 2016; July through September 2016; and October through December 2016. This most recent report assesses the market shares for test strips for the three-month period after the implementation of the current mail-order program, which started on July 1.

The OIG’s previous report for the period April through June 2016 found two strip types accounted for about half of the mail-order market, and the top 10 strip types accounted for 93% of the market.

AAH paper makes case for preserving Medicaid rates

WASHINGTON – AAHomecare has released a briefing paper designed to help HME providers engage state Medicaid programs now that a new law has been passed that limits the federal contribution for HME to these programs to the Medicare rates starting Jan. 1, 2018. The paper, “States Should Not Accept Flawed Medicare Rates,” notes the unsustainable rates facing providers operating under competitive bidding-derived Medicare rates and provides perspectives on the problems with applying these rates to state Medicaid programs. The paper focuses on four arguments: 1) the distinct patient populations and differing missions of Medicare vs. state Medicaid programs; 2) the defective and unsustainable Medicare bidding program; 3) major differences in reimbursement structure between the two programs; and 4) significant geographic variances in patient populations that Medicare rates do not adequately account for. AAHomecare argues “there is no federal requirement for a state Medicaid program to tie its payment limits to Medicare rates,” and that states are, in fact, directed to set their own rates as needed to maintain beneficiary access and a sufficient number of participating providers.

MTA taps Respira, HomeSleep for sleep screening, treatment

PARAMUS, N.J. – The board of the Metropolitan Transportation Authority of New York has awarded Respira-HomeSleep a contract to provide medical services to screen, treat, manage and monitor select MTA employees for obstructive sleep apnea. “We look forward to collaborating with HomeSleep and local DME companies in creating this groundbreaking model of care for the transportation industry,” said Yolanda, Mara Martinez, founder and CEO of Respira. Respira is a respiratory therapy, sleep medicine, DME and healthcare management company. Its custom-tailored programs serve more than 80,000 patients. HomeSleep is a diagnostic company in sleep medicine, providing home sleep devices to patients in their homes to diagnose OSA. “We have put a tremendous amount of time and effort into building a comprehensive sleep program with the Respira team and are confident that together we can assist the MTA and their employees,” said Jonathan Perrone, founder and CFO of HomeSleep.

VGM carves out new role for Clark as chief leadership officer

WATERLOO, Iowa – VGM Group has promoted Dennis Clark, president of its Orthotic Prosthetic Group of America division, to serve as chief leadership officer. In this new role, Clark will lead the advancement of values, mission and brand for the employee-owned company. He will also serve as “post-acute health care visionary and ambassador” across all of VGM’s health care membership communities, according to a press release. Clark is a nationally known prosthetist who has served as president of OPGA for the past 20 years. “I’m proud to have Dennis serving in this important new leadership role,” said Mike Mallaro, CEO of VGM. “Dennis has a unique and powerful insight into VGM’s history, culture and values. He is particularly brilliant at connecting people and ideas, as we as building teams.” Todd Eagan, vice president of the OPGA, will step up to president. He has been with OPGA for six years.

AOPA celebrates centennial

WASHINGTON – The American Orthotic & Prosthetic Association has launched www.aopa100.org, a commemorative website in honor of its 100th anniversary. The website features AOPA’s history, an interactive timeline, photo gallery, personal stories from members, and the association’s plans for the future. “The website celebrates our members’ deep roots and rich history in working together to ensure the viability of O&P for the patients we serve,” said Traci Dralle, chairwoman of AOPA’s Centennial Committee. AOPA will mark its anniversary in other ways this year, including events at the AOPA World Congress Sept. 6-9 in Las Vegas, and Throwback Thursday posts on social media platforms each week.

Lodi Health closes HME store

LODI, Calif. – Lodi Health is closing Memorial Home Med-Equip due to changes in Medicare reimbursement, according to the Lodi News-Sentinel. The full-service store has provided area residents with medical equipment like hospital beds, walkers, canes and oxygen equipment for 33 years. Company officials cite a 50% reduction in reimbursement as the driving factor in the decision. Lodi Health is not alone. There were once three medical equipment supply stores in the city at one time, but they have all disappeared, the newspaper reports. Memorial Home Med-Equip is expected to close some time in February.

Chart Industries taps Quality Medical for repairs

BALL GROUND, Ga. – Chart Industries has appointed Largo, Fla.-based Quality Medical as the authorized service center for its customers in the Southeast. Quality Medical will perform both warranty and non-warranty service for Chart products from its new service facility in Cartersville, Ga. Chart manufactures the AirSep, CAIRE and SeQual brands of stationary and portable oxygen concentrators. “Quality Medical is an experienced service provider for a wide range of biomedical equipment and will play an important role in maintaining the high level of service our customers have come to expect from Chart Industries,” said Miguel Cervantes of Chart Industries.

Quality Medical opens new service facility

LARGO, Fla. – Quality Medical has opened a new service facility in Cartersville, Ga., to better serve customers in Georgia, Alabama, Tennessee, North Carolina and South Carolina. “One of the most important elements of great service is turnaround time and this new facility helps us deliver great service in less time,” said PK Bala, CEO of Quality Medical. The new facility services and repairs respiratory, infusion, and patient monitoring equipment from a variety of healthcare companies throughout the Southeast. Its customers include Chart Industries, Philips Respironics, CareFusion, Flight Medical, B. Braun, Baxter and Abbott. Quality Medical aims to have five locations nationwide by 2020. “This location in Georgia is an important milestone toward this goal as we implement standard procedures of excellence across several locations,” said Jim Worrell, senior vice president of corporate development.

Sperduti picks up the tab at Medtrade Spring

LAS VEGAS – Sales guru Mike Sperduti will lead a free, four-part sales training workshop at Medtrade Spring, Feb. 27-March 1, at the Mandalay Bay Convention Center. All show attendees are eligible to attend, and may pick and choose among the four sessions, held Monday and Tuesday, or attend all four. “I recognize how thankful I am to the HME industry,” said Sperduti, president/founder of the Mike Sperduti Companies/Emerge Sales. “This year I want to pick up the tab for anybody who wants to attend any of the sessions, or all four.” For session descriptions, Click Here. To register, Click Here.

Short takes

BioScrip has joined Keep My Infusion Care at Home, a coalition formed in response to a change in the payment model for Medicare Part B home infusion drugs. The Denver-based BioScrip is a leading provider of infusion and home care management solutions…Staff members of the Board of Certification and Accreditation (BOC)are finalists for two Stevie Awards: Front-Line Customer Service Team of the Year and Business Development Professional of the Year. Finalists were chosen from more than 2,300 nominations. Winners will be announced Feb. 24 at a banquet at Caesars Palace in Las Vegas…Mediware Information Systems is now contracted with more than 30 customers for its CareTend software. Mediware released its latest version of the point-of-sale system in June…The National Association of Specialty Pharmacy has released the NASP Member App. Available for Android and iOS, it allows users to network, strategize and communicate…Rancho Cucamonga, Calif.-based PSP Homecare has launched a targeted marketing strategy featuring new radio, online and direct mail advertising. “We are all very excited to now be positioned to start a greatly expanded advertising campaign for our products and services, all supported by our own new dedicated call center,” said Michelle Ricco, CEO of Proto Script Pharmaceutical Corp, the parent company of PSP Homecare…Exeter, Pa.-based Quantum Rehab will have a theme of “To Be As Independent As Possible” at the International Seating Symposium, March 2-4 in Nashville. It will showcase its Q6 Edge 2.0 power base, iLevel seat elevation and Q-Logic 3 Advanced Drive Control technologies at the event.