In brief: Judge rebukes CMS, Scooter Store speaks
MINNEAPOLIS – A federal judge may have granted the government’s request to dismiss a competitive bidding-related lawsuit filed against CMS by a specialty HME provider, but that doesn’t mean he thinks justice was served. “This is a sad day for those who believe that when a judge adheres, even-handedly, to his or her oath of office, justice will prevail and the public interest will be served,” U.S. District Judge Donovan Frank wrote in a memorandum.
Shoreview, Minn.-based Key Medical Supply, which provides specialty medical equipment to the developmentally disabled, argued in a lawsuit filed March 2012 that the competitive bidding program would cripple the company’s business and jeopardize patient access to equipment and supplies. In the memo, Frank, who presides over the U.S. Court for the District of Minnesota, said he lacked the authority to rule on the legality of competitive bidding, and granted the dismissal on those grounds—albeit with reservations. “While the decision on the motions is supported by law, the court is deeply concerned about the unjust consequences of its order,” he wrote. The memo also contained a strong rebuke of competitive bidding, CMS and the Department of Health and Human Services (DHHS). Frank wrote that the record indicates a “seeming indifference” on the part of the defendants with respect to those with developmental and intellectual disabilities.
Scooter Store CEO: 'We respect' investigation
NEW BRAUNFELS, Texas – A week after federal and state agencies raided its headquarters, The Scooter Store released a statement saying it is complying with the investigation. “We respect the government’s investigation and will continue to work with investigators to make sure they have access to the information they need to conclude their activities,” stated Marty Landon, CEO of The Scooter Store. The Scooter Store is prepared to address any instances of misconduct should the investigation bring any to light, Landon stated. “If we learn of procedural shortcomings or personal misconduct, we will investigate and take appropriate corrective action,” he stated. The Scooter Store remains “fully open for business” during the investigation, Landon stated.
Reps 'concerned' about rates for diabetes testing supplies
WASHINGTON – A pair of lawmakers have asked the Government Accountability Office (GAO) to study the impact of a 72% reimbursement cut, on average, for diabetes supplies as part of a national mail order program. In a letter, Reps. Diana DeGette, D-Colo., and Ed Whitfield, R-Ky., co-chairs of the Congressional Diabetes Caucus, stated they are “concerned about what it will mean for beneficiaries’ access to diabetes testing supplies (DTS) and their ability to maintain their current brand of testing strips.” The congressmen requested that the GAO monitor and report back to Congress on patient access after the cuts take place.
NHIA updates coding standard for home infusion claims
ALEXANDRIA, Va. – The 2013 version of the National Home Infusion Association (NHIA) coding standard has been published and is available free of charge, according to a press release. The annual standard, first published in 2002, represents an effort by the NHIA to advance standardization of claim transactions and coding for all home infusion services. The document presents the Healthcare Common Procedure Coding System (HCPCS) per diem “S” codes as a comprehensive coding system for home infusion therapy claims and provides procedures for their use. It also features information about what’s included in the home infusion per diem, and detailed coding examples for both typical and unusual claims scenarios.
Revenues climb at Insulet
BEDFORD, Mass. – Insulet, a provider of insulin pumps for patients with diabetes, reported $58.7 million in revenues for the fourth quarter of 2012, a 23% increase over the same period in 2011. It reported net losses of $10.2 million vs. $14.3 million. For all of 2012, Insulet reported revenues of $211.4 million, up from $152.3 million in 2011, and net losses of $51.9 million vs. $45.8 million. The increase in revenues was fueled by continued growth of the customer base, both domestically and globally, for the OmniPod, an insulin management system, the release stated. For 2013, Insulet estimates revenues will be in the range of $240 million to $255 million. For the first quarter of this year, it estimates revenues will be in the range of $56 million to $59 million.
Review finds 80% error rate for power wheelchairs
WASHINGTON – A prepayment review of power wheelchair claims processed in Jurisdiction B resulted in an 80% error rate, according to National Government Services (NSG), the DME MAC there. Of 1,022 claims processed from Oct. 1 2012–Dec. 31, 2012, 122 were paid in full, while the remaining claims were completely or partially denied, according to the review. The most common reasons for denials were: Local Coverage Determination (LCD) criteria not met; face-to-face examination with a physician not established; and failure to prove that canes or walkers could not resolve mobility limitations inside the home.
Review finds 85.6% error rate for intermittent caths
WASHINGTON – A prepayment review of intermittent catheterization kits processed in Jurisdiction B resulted in an 85.6% error rate, according to National Government Services (NGS), the DME MAC there. Of 257 claims processed from Sept. 1–Dec. 31, 2012, 220 were denied, according to the review. The most frequent denial—“failure to meet one or more of the required coverage criteria”—accounted for 37% of denied claims. Sixty-one of the claims were denied because the requested documentation was not returned within the required timeframe. Additional reasons for denials include: invalid refill requests; proof of delivery was insufficient or missing; medical records were insufficient; and detailed written orders were insufficient.
Study: Shoe inserts reduce diabetes-related amputations
GOTHENBURG, Sweden – A new study conducted by researchers in Sweden found that shoe inserts could reduce diabetes-related amputations by 50%, according to a press release from Orthofeet, a manufacturer of specialty footwear based in Northvale, N.J. Conducted at the Sahlgrenska Academy, University of Gothenburg, the study suggests that shoe inserts could comprise an essential part of a management program, along with regular check-ups, podiatry and education, that minimizes the incidence of foot ulcers, a leading culprit of lower extremity amputations in diabetes patients. Researchers recently presented the study at the International Society for Prosthetics and Orthotics (ISPO) World Congress in Hyderabad, India.
CMS extends review of K0009
WASHINGTON – CMS has requested an additional 30 days to complete its coding verification review of K0009, a code representing miscellaneous custom ultralight wheelchairs, according to a bulletin from Noridian Administrative Services. The review is designed to resolve issues involved with classifying these items under the HCPCS. The new effective end date for all products currently coded K0009 is April 30, 2013, and manufacturers that submitted a coding verification application to the PDAC prior to Dec. 3, 2012, will be notified on April 1, 2013.
Vendor short takes
HQAAhas launched a new accreditation program designed specifically for providers of facility-based ventricular care units (FBVU). The accreditation is available for any facility-based ventilator care provider and is tied to the business entity providing the care, whether it’s owned by the facility or an outside contractor… Signature Sleep Services (d/b/a Sleep 960) and C-PAP Horizon Project have agreed to integrate their sleep products and services, and combine their marketing efforts, according to a press release. Sleep960 provides diagnostic and therapy products, consultation and management services, and PSG educational courses. C-PAP Horizon provides technology and business services for HME providers who specialize in sleep therapy.