In brief: Industry survey, Hill hits

Sunday, May 17, 2009

MARTINEZ, Ga. - The Committee to Save Independent HME Suppliers (CSI: HME) wants to know where providers stand on oxygen reform and other industry issues. The group sent a survey to all state, regional and national industry associations and member-service organizations last week. CSI: HME will use the results to "determine the majority position of the industry and advance that position through its lobby and public relations efforts," it stated in a release. To view the survey, go to:

Hill hits: Reform and a familiar face

WASHINGTON - The House of Representatives plans to have a healthcare reform bill ready for a vote by the end of July, House Speaker Nancy Pelosi, D-Calif., stated last week. That gives the HME industry, which seeks to delay or rescind national competitive bidding, repeal the 36-month oxygen cap and implement oxygen reform, less than three months to become part of the discussion...Kathleen Sebelius, the new secretary of the Department of Health and Human Services, created a new department last week to help pass healthcare reform: the HHS Office of Health Reform. The office will work closely with the White House Office of Health Reform. It will be led by Director Jeanne Lambrew...Herb Kuhn, a former deputy administrator of CMS, has been appointed to the Medicare Payment Advisory Commission (MedPAC).

AAH, CMS meet

ARLINGTON, Va. - AAHomecare's Regulatory Council met with CMS staff last week to discuss national competitive bidding, the 36-month oxygen cap, wheelchair repair policies and other issues. Council members met with Program Integrity staff, including director Kim Brandt. Brandt told the council that CMS plans to increase front-end anti-fraud efforts, focusing on the enrollment process. Les DeFelice, a council member and president and CEO of DeFeliceCare in Wheeling, W.Va., asked Brandt to help correct misperceptions about fraud in the HME industry. Also at the meeting, Brandt said the National Supplier Clearinghouse is hiring more staff to verify accreditation and surety bond compliance. Other topics addressed: CPAP policy, negative pressure wound therapy, supplier standards and DME MAC issues.

Oxygen: DME MAC releases claims denial help

WASHINGTON - Noridian Administrative Services, the DME MAC for Jurisdiction D, released instructions last week for providers to "resubmit oxygen rental claims for subsequent months if they have received payment for the initial replacement month." The impetus for the instructions: Some providers have experienced non-covered denials with N370 messages (billing exceeds the rental months covered/approved by the payer). This occurs because "the claim with the RA or RP modifier has not yet been worked by their claims staff and the new CMN for the replacement equipment was not yet loaded into the claims processing system." Claims that should be resubmitted: those with dates of service Jan. 17 through March 31, 2009. For complete instructions, visit

Coalition seeks wheelchair cushion carve out

WASHINGTON - A group of disability advocates sent a letter to the Department of Health and Human Services last week, urging Secretary Kathleen Sebelius to exempt specialty wheelchair seating cushions from national competitive bidding (NCB). In the letter, the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition states that if the cushions are put out to bid, some providers could switch to less-costly products, affecting beneficiary access. ITEM points out that the cushions are important to manage pressure sores and other complications related to long-term wheelchair use. They are fitted to the user by a team of therapists, mobility device engineers and suppliers.

Group to Medicare: Save by expanding home health care

WASHINGTON - Medicare could save $30 billion in 10 years by expanding access to home health for chronic disease patients, according to a study released last week by the Alliance for Home Health Quality and Innovation (AHHQI). AHHQI--comprised mostly of home health nursing agencies--contracted Avalere Health in October 2008 to analyze Medicare data from 2005 and 2006, the most current available. It found that early use of home healthcare services following a hospital stay for beneficiaries with at least one chronic disease saved Medicare $1.71 billion in those two years. It believes an additional $1.77 billion would have been saved in the same period if all beneficiaries with similar chronic diseases had accessed home healthcare services. AHHQI points out that 86% of people who qualify for Medicare have at least one chronic condition and 40% have three or more. But only 8.9% of Medicare beneficiaries currently use home health services, a fact attributed in large part to the program's requirement that an individual be "homebound" and unable to leave the home without significant assistance in order to receive the benefit, the group says. To read the full study, visit