In brief: CMS reports glitch, OIG reports overpayments

Friday, January 17, 2014

NASHVILLE, Tenn. – A problem with ordering/referring physician data in the DME MAC claim system is affecting processing, as well as the data available in the myCGS web portal and the Jurisdiction C IVR, according to a bulletin from CGS. CMS and DME MAC system maintenance contractors are researching the issue. CGS says it will provide more information when it becomes available. CMS on Jan. 6 started denying claims with the names of physicians who are not enrolled in PECOS.

Medicare overpays for VES, report finds

BALTIMORE – Medicare payments for vacuum erection systems (VES) are more than twice the amount paid by other payers, such as the Veterans Affairs, and the amount paid by consumers online, the Office of Inspector General (OIG) has found. The OIG recommends CMS determine whether the payments are “grossly excessive” and, if they are, seek legislative authority to add VES to the competitive bidding program, which most recently resulted in a 45% reduction in payments for certain HME. By adjusting the Medicare fee schedule, the government could have saved $14.4 million for each of the six years reviewed and beneficiaries about $3.6 million, according to the report.

Bill seeks to lift ban on supply deliveries

ALEXANDRIA, Va. – Two senators have introduced a bill that would allow independent community pharmacies to deliver diabetes testing supplies to Medicare beneficiaries the same day an order is placed. The bill, introduced by Sens. Jerry Moran, R-Kan., and John Thune, R-S.D., would reverse restrictions placed on community pharmacists on July 1, 2013. “Pharmacists have reported cases of seniors going out in hazardous circumstances and risking a debilitating fall or other accident to obtain diabetes testing supplies because the local pharmacy can no longer deliver them,” said Douglas Hoey, CEO of the National Community Pharmacists Association, in a Jan. 16 release. “Now more than ever, Congress should scrap this indefensible delivery ban.”

Comparative billing report on CPAP due this month

BALTIMORE – eGlobeTech will provide comparative billing reports (CBR) on CPAP devices and accessories to providers in mid-January as part of a contract with CMS. The reports will feature tables, graphs and an explanation of findings comparing billing and payment patterns in states across the nation, according to a bulletin from CMS. The reports will offer only summary billing information to protect privacy.

Bill takes aim at FAA’s sleep apnea policy

WASHINGTON – A bill introduced Jan. 16 in the Senate would require the Federal Aviation Administration (FAA) to follow a rulemaking process before changing its sleep apnea policy, according to news reports. Faced with stiff opposition from some pilot groups, lawmakers and physicians, the FAA recently put on hold its plans to require pilots with body mass indices of more than 40 to be screened for sleep apnea. “Testing private pilots for sleep apnea might be a worthwhile idea but the agency should have talked to its stakeholders first,” said Sen. Mark Begich, D-Alaska. “If they had been willing to listen to the aviation community they might have found smarter and less intrusive ways to ensure pilots are safe to fly. The irony is that sleep apnea has never been identified as a factor in a general aviation incident.”Late last year, Congress stepped in to require that the Federal Motor Carrier Safety Administration go through a similar process before issuing sleep apnea guidelines for truckers.

Cushions up for prepayment audit

NASHVILLE, Tenn. – CGS, the DME MAC for Jurisdiction C, will implement a prepayment edit for E2603 (skin protection wheelchair seat cushion, any depth, but less than 22 inches wide) and E2622 (adjustable skin protection wheelchair seat cushion, any depth, less than 22 inches wide). The contractor is conducting the edit because of high claims payment error rates for this product category, according to a Jan. 14 bulletin. For claims subjected to the edit, providers will need to provide delivery documentation; detailed product description (for motorized base) or written order (for manual base); medical records demonstrating need; and advanced beneficiary notice. Providers must file the additional documentation within 45 days of notification or the claim will be denied, according to the bulletin.

VGM raises $12,000 for stolen wheelchairs

WATERLOO, Iowa – The VGM Group dressed down to help the Iowa Chariots get back on the court. During the week of Dec. 30, employees could pay $10 to dress casually to raise money to replace the team’s stolen wheelchairs. Both VGM and company founder Van G. Miller matched each dollar raised and U.S. Rehab also made a donation. The total amount raised: $12,000, according to a Jan. 13 release. “In our industry, we understand that a wheelchair means independence and it allows a person to live the best quality of life possible,” said Greg Packer, U.S. Rehab president. “We know that wheelchair athletes are the real deal and we hope this contribution helps keep the Chairiots competing.” The Chairiots have raised about half of the $40,000 to $50,000 needed to replace the stolen wheelchairs, according to the release.

Orthofeet, AADE promote foot health

NORTHVALE, N.J. – Specialty footwear maker Orthofeet is working with the American Association of Diabetes Educators (AADE) to develop an educational campaign promoting foot health for adults with diabetes, the company announced recently. Preventative care and therapeutic shoes can help diabetics maintain foot health and avoid neuropathy, according to the statement. “There are many teaching tools to help patients understand how to monitor glucose levels or eat a healthy diet, but there are very few resources that communicate the importance of daily foot care for this population,” said Bill Wald, vice president of corporate relations and development for AADE, in the release. The curriculum, developed by Dennis Janisse, the scientific affairs director at Orthofeet, and AADE, will be available for diabetes educators to share with their patients.

Study links spinal-cord injuries, sleep apnea

DETROIT – Ninety-two percent of patients with spinal-cord injuries sleep poorly and 77% suffer from symptomatic sleep disordered breathing, according to a study published Jan. 15 in the Journal of Clinical Sleep Medicine. “Sleep disordered breathing may contribute to increased cardiovascular mortality in spinal cord injury patients,” said M. Safwan Badr, president of the American Academy of Sleep Medicine, and a researcher involved in the study. “All spinal cord injury patients should undergo a comprehensive sleep evaluation using full, overnight polysomnography for the accurate diagnosis of sleep apnea.” Researchers studied 26 spinal cord injury patients, 15 with cervical injuries and 11 with thoracic injuries, and found central sleep apnea was more common in those with cervical injuries.

Convaid redesigns website

TORRANCE, Calif. – Convaid has launched a redesigned website. The site features easy navigation with separate sections for dealers, medical professionals, patients and families. It also features updated industry resources, brochures and online order forms. “Convaid’s new enhanced website will serve as a valuable tool and source of information,” said President Chris Braun in a release.

Ottobock earns state tax credit for expansion plans

SALT LAKE CITY – Utah is giving Ottobock a $392,000 post-performance tax credit to help the manufacturer add more than 80 jobs at its expanding Salt Lake City facility, the Salt Lake Tribune reports. The credit represents about 20% of the $2 million in new taxes the company is expected to pay over the seven-year term of its deal with the Utah Governor’s Office of Economic Development, according to the story. Fifty-five of the new jobs generated will pay at least 125% of Salt Lake County’s minimum wage, generating $16.2 million in new wages over seven years. Ottobock plans to invest $1 million to expand its Salt Lake City facility and relocate two divisions from Minneapolis there. In other company news, two American snowboarders will compete in the Sochi Paralympics using Ottobock prosthetics.

Wheel:Life book provides fundraising tips

SANDY SPRINGS, Ga. – Wheel:Life, an online community for wheelchair users, has published Lisa Wells’ e-book, “10 Fundraiser Ideas to Help People with Disabilities.” In it, Wells shares ideas about how to raise money for people who need financial help with medical equipment, rehab, daily medical needs or adaptive sports equipment. “Wheel:Life receives hundreds of inquiries each year from people who are seeking advice on ways to raise money for medical equipment, adaptive sports gear or specialized health care,” said Wells, who has worked in healthcare marketing for more than 20 years. “While Wheel:Life doesn’t have the funds to financially support these requests, we are able to provide intelligent support by offering resources like this book.”The book is available for purchase at Amazon’s Kindle bookstore.

Contractor warns of delays with paper claims

INDIANAPOLIS – National Government Services (NGS), the DME MAC for Jurisdiction B, is experiencing delays updating the optical character recognition system it implemented to process CMS-1500 paper claims. Effective April 1, all paper claims must be submitted in that format; any files using the older format will be returned as unprocessable. Because of the delays, NGS is manually verifying paper claims data and has increased the inventory of paper claims awaiting validation, according to a recent bulletin. “Until these paper claims are entered, we cannot fully respond to claim status related questions,” the bulletin states. “The claims may have been received and are awaiting claim detail entry into the Multi Carrier System. An extensive effort is underway to expedite processing for these outstanding paper claims.” The problem only affects paper claims; most electronically submitted claims and claims submitted using free features on the NGSConnex portal are being processed on time, according to the bulletin.

CareFusion to pay $40.1M for kickback scheme

SAN DIEGO – CareFusion will pay the government $40.1 million to settle, without liability, government allegations that it paid kickbacks and promoted products for uses not approved by the U.S. Food and Drug Administration (FDA), according to a Jan. 9 release. The government charged that CareFusion paid $11.6 million to Dr. Charles Denham, then co-chairman of the Safe Practices Committee at the National Quality Forum, to recommend and promote ChloraPrep products, encouraging providers to purchase them, according to the statement. “When companies pay kickbacks to doctors, especially doctors involved in setting standards for the health care industry, they undermine the integrity of the health care system,” said Stuart Delery, assistant attorney general of the Department of Justice’s Civil Division, in a statement. The settlement resolves a case filed by Dr. Cynthia Kirk under the whistleblower provision of the False Claims Act. Her share of the settlement: $3.26 million. CareFusion previously disclosed the settlement in April of 2013.

Short takes

Tricia Huong Thi Nguyn has been appointed to BioScrip’s board of directors and will serve on the Nominating and Governance Committee and the Corporate Strategy Committee. Nguyen, president of the Texas Health Population Health, Education, Research and Innovation Center, has more than 20 years of leadership experience in managed care and health insurance…Courtney Sanchelli has won the Most Inspirational Client Award from Maddack and Morph Wheels. Quadriplegic and on a ventilator since she was in a car accident at age four, the 17-year old will receive a set of Morph foldable wheelchair wheels…Global revenue for the telehealth market is expected to reach $4.5 billion in 2018, up from $440.6 million in 2013, according to a new report from IHS Technology. The use of medical devices and communication technology to monitor patients’ symptoms and manage chronic diseases reduces readmission and mortality rates, while increasing adherence, according to the report…Molnlycke, a Swedish medical supply company, is investing between $5.5 million and $7 million in a new Wiscasset, Maine, facility where it will manufacture the foam used in its wound care products, according to news reports. The company expects to add 10 to 30 jobs in the next five years.