In brief: CMS sleep policy, oxygen billing issue

Sunday, March 8, 2009

BALTIMORE - Providers shouldn't find anything new in the final coverage policy for sleep testing that CMS released last week. The policy simply finalizes already existing language that provides coverage for specified sleep tests--those performed in labs and at home--to confirm the diagnosis of patients who have clinical signs and symptoms of obstructive sleep apnea. According to a CMS release: "With this decision, CMS will have nationally consistent coverage for sleep testing for the diagnosis of OSA. The tests have previously been covered by local Medicare contractor policies, which, in some cases, varied from state to state."

Oxygen cap: Noridian address "break in billing"

FARGO, N.D. - When billing for oxygen equipment for a break in billing, resulting in a date of service after 36 months, providers must include a narrative stating "extend CMN" on their claims, according to a bulletin issued last week by Noridian Administrative Services, the DME MAC for Jurisdiction D. They must also include an explanation of why there was a break in billing. The narrative should be submitted in item 19 on the CMS 1500 claim form or in the NTE segment, 2400 loop for electronics claims. For more information, go to

CMS schedules surety bond forum

BALTIMORE - CMS will hold a Special Open Door Forum on the new surety bond requirements for DMEPOS suppliers on Tuesday, March 17, from 2 p.m. to 3:30 p.m. In December, CMS announced that existing suppliers must obtain one surety bond for each national provider identifier number by Oct 2, 2009. Next week's teleconference will cover exemptions to the requirement; implementation dates; the definition of a final adverse action; and elevated surety bond amounts. To participate, call 1-800-837-1935. Conference ID: 88857015.

Senate joins pharmacy carve out efforts

ALEXANDRIA, Va. - Sens. John Tester, D-Mont., and Sam Brownback, R-Kan., introduced S. 511, the Access to Durable Medical Equipment Act of 2009, last week. The bill seeks to exclude pharmacists from Medicare accreditation requirements. The National Community Pharmacists Association says requiring pharmacies--which typically do only limited amounts of DME and diabetic supplies--to become accredited could limit patient access. In rural states like Montana and Kansas, patients may have to travel long distances to obtain supplies. The bill is a companion to H.R. 616, which was introduced in January by Reps. Marion Berry, D-Ark., and Jerry Moran, R-Kan.

Lawmakers, patients push for infusion coverage

WASHINGTON - Sen. Johnny Isakson said he witnessed firsthand the value of home infusion therapy when his son needed treatment. "I believe he was able to heal faster because he underwent treatment at home. Everyone should be afforded this opportunity," stated Isakson at an educational forum hosted by the National Home Infusion Association March 5. He was joined by Sen. Blanche Lincoln, D-Ark., and Rep. Eliot Engel, D-N.Y., along with home infusion patients to drum up support for the Medicare Home Infusion Therapy Coverage Act of 2009. The bill, introduced in January, seeks to have medical services, supplies and equipment needed to deliver the home therapy under Medicare Part B. Currently only the drugs are covered--under Part D.

HDI reports profit increase

FORT LAUDERDALE, Fla. - Diabetes manufacturer Home Diagnostics last week reported a 6.4% increase in revenues for the fourth quarter of 2008. Total revenue for the quarter was $29.5 million, up from $27.8 million for the same quarter in 2007. Gross profit for the quarter was $15.1 million, compared to $16.4 million in 2007. As a percentage of sales, gross margin decreased to 51.2% from 59.0%. Retail sales were up 14.6%, driven by the launch of TRUEresult and TRUE2go monitoring systems in Walgreens and Rite Aid and the TRUEtrack in Walmart. Mail service channels increased 5.6% for the quarter, including the launch of a private label system with Liberty Medical. Total revenues for the full year ended Dec. 31, 2008, were $123.6 million, an increase of 6.9% from $115.6 million in 2007.

Medline partners up

MUNDELEIN, Ill. - Medline Industries inked a three-year, $1.8 million deal to provide advanced wound care products to Catholic Healthcare West (CHW), the company announced last week. CHW is the nation's eighth largest hospital system and has a network of 41 hospitals and medical centers in California, Arizona and Nevada. Medline's wound care products include its SilvaSorb antimicrobial silver dressings, Maxorb Calcium Alginates, Exuderm Odorshield and Optifoam dressings.