In brief: HHS releases final ACO reg, industry-hosted town hall draws thousands of beneficiaries

Thursday, October 20, 2011

WASHINGTON – The Department of Health and Human Services (HHS) last week released its final regulation on accountable care organizations (ACOs), which reflects “significant input provided by stakeholders, as well as lessons learned,” according to a release. The regulation outlines two initiatives—the Medicare Shared Savings Program and the Advance Payment model—that will help providers form ACOs. The Medicare Shared Savings Program will provide incentives for participating providers who agree to work together and become accountable for coordinating care for patients. The Advance Payment model will provide additional support to physician-owned and rural providers participating in the Medicare Shared Savings Program. To read the release and get more info, go to

Industry-hosted town hall draws thousands of seniors

CINCINNATI – About 12,000 Medicare beneficiaries here participated in a town hall teleconference last week on how competitive bidding will impact access to quality HME and services. Beneficiaries on the call, hosted by Last Chance for Patient Choice and the Ohio Association of Medical Equipment Services (OAMES), heard from a Cincinnati dentist with COPD who credits his ability to continue working to providers who service his oxygen needs and others. About 250 beneficiaries opted to “press through” and connect with Congress members who represent the Cincinnati bid area to ask them to support H.R. 1041, a bill to repeal the program.

AAH names homecare champions

ATLANTA – AAHomecare will honor Tom Ryan of Homecare Concepts and Joe Lewarski of Invacare with Homecare Champion awards at its Standup for Homecare reception at Medtrade this week. The award recognizes AAHomecare members for contributions to the homecare community throughout an individual’s career. Ryan is president and CEO of Farmingdale, N.Y.-based Homecare Concepts. Lewarski is vice president of clinical affairs at Invacare.

HME is essential, AAH says

ALEXANDRIA, Va. – AAHomecare has asked the Department of Health and Human Services (DHHS) to include home medical equipment and services as an essential benefit under the health insurance exchange plans mandated by the Affordable Care Act. DHHS is collecting comments in advance of a proposed rule on essential health benefits. Although the ACA did not specifically include HME, it did include a "rehabilitative and habilitative devices" category.

HHS details RAC program for Medicaid

WASHINGTON – The Department of Health and Human Services (DHHS) last week released its final rule for the Medicaid Recovery Audit Program. The rule contains details like: Recovery Audit Contractors (RACs) can only go back three years from the claim date; and must employ nurses, therapists, certified coders and a physician. Also: Independent auditors will be paid contingency fees out of any improper payments recovered; RAC auditors cannot audit claims that have already been audited or are currently being audited; and states may exclude Medicaid managed care claims from RAC reviews and set limits on the number and frequency of medical records to be reviewed. RAC audits will begin in January. DHHS expects the audits to save $2.1 billion over the next five years.

MA plans to limit coverage to specific manufacturers?

BALTIMORE – CMS has proposed allowing Medicare Advantage plans to limit coverage of durable medical equipment to specific manufacturers or brands, if certain conditions are met. In an Oct. 11 rule, CMS says MA plans could restrict coverage if they meet requirements related to access and medical necessity, transition periods, mid-year changes to preferred DME and supplies, appeals and disclosure of coverage limitations. The proposal is based on a 2011 policy that permits different cost-sharing levels for DMEPOS and Part B drugs. The rule can be found at

Premier settles complaint, Seacoast pleads guilty

Premier Home Care in Jeffersonville, Ind., agreed to pay $578,820 to the United States and $21,180 to Indiana to settle claims that the provider used unlicensed technicians to set up CPAP machines, according to the News and Tribune. In 2008, a former employee filed two whistleblower complaints against Premier Home Care. The complaints alleged Premier violated the False Claims Act by falsely certifying that it was in compliance with Indiana state licensure laws. In a statement, Wayne Knewasser, vice president of public relations for Premier, denied any wrongdoing...Peter Enzinger, president of Seacoast Sleep Solutions, pleaded guilty to healthcare fraud Oct. 18, according to the Bangor Daily News. Enzinger was accused of billing public and private insurance of $220,000 between 2005 and August 2010 for products that were either not delivered and for more expensive products than those delivered.

Under review in Jurisdiction B: CPAP, O2, diabetes

A widespread prepayment review by National Government Services, the Jurisdiction B DME MAC, revealed an 81% error rate for CPAP devices (E0601KJ), according to a recent bulletin. Out of 100 claims reviewed, 19 were allowed. The top reasons for denial: lack of or insufficient medical record documentation of a face-to-face evaluation prior to the sleep study (32); lack of or insufficient documentation of the re-evaluation between 31 and 90 days of therapy; no documentation received (27); and lack of or insufficient documentation of adherence to therapy (27). The review is ongoing…Also in Jurisdiction B, the CERT contractor has announced it will begin widespread documentation compliance reviews for oxygen and oxygen equipment, and diabetes supplies. The reviews are in response to high error rates. Suppliers who receive additional documentation requests will have 30 days from the date on the letter to respond. For more info:

Short takes: Ita-Med, DeVilbiss, Drive

Ita-Med announced last week that it has received Medicare approval for two new bio-magnetic lumbo-sacral supports under its Maxar brand, the BMS-511 and the BMS-512. Medicare has assigned BMS-511 and BMS-512 the HCPCPS code L0627 and reimbursement of up to $367…DeVilbiss Healthcare announced last week that its sleep therapy interfaces and IntelliPap supplies are available through PPM Fulfillment Services. Located in Louisville, Ky., PPM is a full logistical support service that provides drop-shipping services for HME companies…Acu-Serve Corporation and Jane’s Healthcare Consulting announced last week that they have partnered to provide HME providers with billing, compliance and auditing services and consulting…Drive Medical announced last week that, through its subsidiary Inovo/Chad Therapeutics, it has hired Richard Kocinski as vice president of respiratory business development. Kocinski will report to George Harris, CEO of Inovo/Chad.