In brief: Face-to-face rule, IR meeting, PWC prepay review

Tuesday, July 10, 2012

BALTIMORE – CMS issued a proposed rule this week that details its plans to require a face-to-face evaluation within 90 days of a written order for certain high-cost durable medical equipment.

The rule gives four criteria that would subject items to the requirement:

1.)    items that currently require a written order prior to delivery;
2.)    items that cost more than $1,000;
3.)    items that we, based on our experience and recommendations from the DME MACs, believe are particularly susceptible to fraud; and
4.)    items determined by CMS as vulnerable to fraud based on reports of the Office of Inspector General, Government Accountability Office or other oversight activities.

Included in the rule: a table on p. 263 that lists “specified covered items” like TENS units, rollabout chairs, manual wheelchair accessories, oxygen and respiratory equipment, hospital beds and accessories and traction equipment-cervical.

“Note that the proposed list does not include power mobility devices, which are subject to already existing face-to-face requirements, as previously discussed,” CMS stated. “In addition, we propose to add to the list any item of DME that in the future appears on the DMEPOS Fee Schedule with a price ceiling at or greater than $1,000. Items not included in one of the proposed automatic pathways would be added to the list of Specified Covered Items through notice and comment rulemaking.”

The rule will appear in the Federal Register July 30, 2012.


Meeting agenda: Is fee schedule for diabetes supplies ‘grossly excessive’?

BALTIMORE – CMS will use a July 23 public meeting with industry stakeholders to determine whether the current fee schedule for retail diabetes supplies is “grossly excessive,” the agency stated in a special note this week. Following the meeting, CMS will decide whether to pursue IR vs. competitive bidding to achieve more appropriate pricing for these items. “Decisions regarding whether to propose inherent reasonableness payment limits for these items and services, what data and pricing information to use, and when such limits would take effect will be examined by CMS and made after the meeting and would be included in a proposed notice for public comment published in the Federal Register,” the agency stated. The meeting will take place from 9 a.m. to 1 p.m. EST at CMS headquarters at 7500 Security Boulevard in Baltimore.

Linde raises money for Lincare buy

MUNICH, Germany – Linde AG has sold 12.8 million new shares to raise $1.7 billion to put toward its $4.6 billion purchase of Lincare Holdings, the industrial gas giant announced this week. The capital increase is only one way Linde plans to raise money. “We will continue to implement our financing strategy, which is geared toward safeguarding liquidity and adopting a long-term approach, a strategy which is rewarded by the rating agencies.

Rotech’s Carter gives notice

ORLANDO – President and CEO Philip Carter has notified Rotech Healthcare that he plans to retire effective Dec. 31, 2012. Carter will remain on the provider’s board of directors. The board intends to initiate a search process to select Rotech’s next president and CEO and to engage an executive search firm to assist in the process of evaluating external and internal candidates. “On behalf of the board and the entire company, I would like to thank Phil for his extraordinary leadership over these past 10 years,” stated Arthur Reimers, chairman of the board, in a press release. “The company’s operations are well positioned for the future, and the company has a strong management team in place. Based on the transition plan the company implemented last year with the amendment of Phil’s agreement, the company believes we now have ample lead time for an orderly transition.”

GMEA buys A&A Medical

PHOENIX – Global Medical Equipment of America (GMEA) has acquired A&A Medical Supply, a full-service DME provider covering the Baltimore-Washington, D.C., market. The acquisition allows GMEA to “begin penetration into the Mid-Atlantic region,” the company stated in a press release. “A&A enables us to expand into a strategic demographic with a solid company bringing much talents to GMEA,” stated Harold Halman, CEO of GMEA.

Noridian targets eight PWC codes for prepay review

FARGO, N.D. – Noridian Administrative Services, the Jurisdiction D DME MAC, will be initiating a widespread prepayment review of claims for eight power wheelchair codes. The codes: K0813, K0821, K0822, K0823, K0824, K0825, K0850 and K0861. Noridian is conducting the review based on the results of a CERT review analysis. Providers of the selected claims will receive an ADR letter asking for specific information to determine in the item billed complies with the existing reasonable and necessary criteria. Failure to comply within 45 days of the date on the letter will result in a denied claim. FMI:


These new rule will effectively eliminate patients receiving oxygen, lightweight manual wheelchairs, hospital beds, air loss mattress, etc. upon discharge from nursing homes, hospitals, or other short-term facilities.  I am pretty sure the new face to face requirments will have some questions or criterias that doctors must document in their progress notes upon discharging a patient to receive this equipment.  Most, if not all of the physicians, simply state what type of equipment the patient needs after discharge to be used at home to help him/her recover.  Currently, most patients that are discharged from hospital or nursing home have to wait approximate 4-8 weeks (if ever) to receive a motorized wheelchairs as short-term care physicians do not properly complete face-to-face evaluations for power mobility in their progress notes.  With the new rule, patients should expect same wait time for oxygen, manual wheelchairs, hospital beds or air loss mattresses.  

This is terrfic news for people recovering from broken hips, strokes, knee replacements, and other ailments. Pun intended.

This is just another instance that individuals setting up these guidelines have no real life experience dealing with patients that actually require this type of medical equipment. Sad state of affairs.