In brief: Lobbying, neb-med coverage, pre-payment review

Sunday, August 26, 2007

WATERLOO, Iowa - Nearly 50 home medical equipment providers and industry executives attended last week's fundraiser for Sen. Chuck Grassley, R-Iowa, according to a statement released by The VGM Group.

The fundraiser, which took place at the home of Van Miller, the CEO and founder of VGM, raised nearly $70,000 for Grassley, a ranking member of the powerful Finance Committee.

Attendees told Grassley that they're depending on him to protect the HME industry from further cuts. When legislators return to Washington, D.C., next month, they must combine House and Senate bills that expand the State Children's Health Insurance Program (SCHIP). The House's bill includes provisions to further reduce the oxygen cap to 18 months and eliminate the first-month purchase option for power wheelchairs.

Grassley told attendees that he would meet with Sen. Max Baucus, D-Mont., chairman of the Finance Committee, to convey their concerns. He also told attendees that he would help them set up appointments with their legislators.

Pride Mobility's Seth Johnson, who attended the event, said this about Grassley's commitment to the HME industry:

"He indicated that he would fight very hard to keep the Medicare provisions out of the SCHIP bill," said Johnson, Pride's vice president of government affairs.

Nebulizer update
WASHINGTON - CMS issued coverage criteria Aug. 24 for Perforomist and Brovana, the two newest nebulizer medications to hit the market.

For dates of service on or after May 11, 2007, the drugs will be covered if:

* They're medically necessary for managing COPD; and

* The patient has a documented history of routine use of at least four doses per day of FDA-approved albuterol or metaproterenol inhalation solution or at least three doses per day of FDA-approved levalbuterol.

Providers should bill both drugs under code J699 using a KO modifier.

Surgical dressings review
WASHINGTON - Tricenturion is continuing its widespread pre-payment review of foam dressings (A6209--A6214) billed with the AI modifier.

A second quarter review of foam dressings revealed denials of nearly all claims billed with the A1 modifier in jurisdictions A and B.

TriCenturion's probe of payments for A6209-A6214 revealed a denial rate of 99.25% in Jurisdiction A and 98.77% in Jurisdiction B. Of those denials, 71% in Jurisdiction A and 65% in Jurisdiction B were denied as not medically necessary, and 28% and 35%, respectively, were denied for no response.