In brief: MACs ease denial process, Philips buys NightBalance

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Friday, May 11, 2018

WASHINGTON – The DME MACs are adding modifiers that will allow HME providers to provide additional information related to the coverage and/or liability when the policy criteria are not met for oxygen patients.

“The benefit of this change is that suppliers can now file an oxygen claim when a patient doesn’t qualify and get an accurate PR (patient responsibility) denial,” AAHomecare wrote in a bulletin.

Effective for claims with dates of service on or after Aug. 1, providers should use:

  • the KX modifier when the requirements specified in the medical policy have been met;
  • GA for a waiver of liability (expected to be denied as not reasonable and necessary, ABN on file);
  • GY for item or service statutorily excluded or does not meet the definition of any Medicare benefit;
  • or GZ for item or service not reasonable or necessary (expected to be denied as not reasonable or necessary, no ABN on file).

AAHomecare says stakeholders have been requesting these changes for “many years.”

Philips buys NightBalance

AMSTERDAM, the Netherlands – Royal Philips has expanded its sleep and respiratory care portfolio with the acquisition of NightBalance, the Delft, Netherlands-based maker of the Sleep Position Trainer. The SPT is a device worn around the upper body that, once users turn onto their backs, gives them a gentle vibration, reminding them to change sleeping positions.

“NightBalance offers a unique, patient friendly solution to treat positional obstructive sleep apnea and positional snoring that is highly complementary to our current offerings," said John Frank, business leader, Sleep & Respiratory Care, Philips. "This acquisition will help us further expand our leadership position in the growing home care market, and our ability to deliver integrated solutions that drive efficiencies and improved outcomes.”The SPT is CE marked and currently available in select countries in Europe, but not in the U.S. Terms of the deal were not disclosed.

MSC buys assets, opens three sleep centers

CLEVELAND – Medical Service Co. has acquired the assets of St. Vincent Home Medical, which serves the greater Indianapolis market and supports St. Vincent Health System. MSC is already the preferred provider for HME throughout the area for St. Vincent Health System, part of Ascension Health. “As a result of this partnership, we are opening three CPAP Therapy Centers and a central distribution center to support our new patients and partners in the region,” MSC stated in a press release. MSC recently launched a new division, MSC Sleep, and opened five centers in Ohio, New York and Kentucky. 

Degen Berglund closes store dues to industry challenges

LA CROSSE, Wis. – Degen Berglund plans to close its home medical services store, laying off 30 employees, according to a local TV station. The company says it is selling its CPAP business to Family Medical Supply and CPAP, also located in La Crosse, and will now focus on its pharmacy and retail businesses. In a statement, the company told the station that industry challenges have made it more difficult to provide service to people needing DME and CPAP. The layoffs will begin in phases, starting July 8 and continuing through Aug. 31.

MACs retire ‘Dear Physician’ letter for limbs

WASHINGTON – The DME MACs are retiring the “Dear Physician” letter for artificial limbs, according to a bulletin from the American Orthotics & Prosthetics Association. The letter is being retired following recently passed legislation that requires the recognition of the prosthetists’ notes as part of the patient’s medical record. The letter, originally published in 2011, dramatically changed the standards for approving a prosthetic claim by disregarding the prosthetist’s notes as part of the medical record, leading to higher claim denial rates, according to AOPA. The association in 2013 *sued CMS over its auditing practices.

Sign-on letter circulates to protect complex rehab

WASHINGTON – Complex rehab stakeholders seek signatures for a letter to CMS asking the agency not to apply a provision in the 21st Century Cures Act to complex rehab technology. Stakeholders are collecting signatures for the letter, spearheaded by Reps. Bill Johnson, R-Ohio, and Robert Latta, R-Ohio, until May 17. A provision in the Cures Act requires CMS to limit federal contributions to Medicaid reimbursement to competitive bidding-influenced Medicare reimbursement. Stakeholders argue that, because complex rehab has been exempted from the bid program, the provision should not apply to that technology.

Golden adds ‘human touch’ to website

OLD FORGE, Pa. – Golden Technologies has officially launched a live web chat service to assist retailers and consumers with their questions. The company has chosen Facebook Messenger as its platform for the service, due to its familiarity to the general public and its user-friendliness. Users of the service, which had its soft launch in January, say it provides a much appreciated “human touch” to the website. “I’ve found that there are all kinds of reasons people use the chat,” said Sarah Market, a customer service representative at Golden. “It is a useful tool for our hearing impaired customers and customers who are constrained by mobility issues, apart from customers who just don’t have time to get into a discussion on the phone. I feel like it puts us within reach of the customer.” For retailers, the service allows them to, among other things, quickly find out what products are in stock and get answers to not-so-frequently-asked questions.

Numotion adds financing option

BRENTWOOD, Tenn. – Numotion has partnered with CareCredit to offer customers a solution for any out-of-pocket expenses. CareCredit, a healthcare credit card that is accepted at more than 200,000 provider and merchant locations, offers promotional financing for transactions greater than or equal to $200 that includes no interest if paid in full within 12 months, or an additional option for reduced APR with equal monthly payments for up to 24 months. “We need to ensure our customers have options when it comes to financing,” said Tamas Feitel, CFO at Numotion. “We are excited about our partnership with CareCredit because it offers our customers flexibility in obtaining high impact mobility solutions to meet their needs.” Other CareCredit partners include Golden Technologies and Applied Home Healthcare Equipment.

AAH taps Bachenheimer for general counsel

WASHINGTON – AAHomecare has retained Brown & Fortunato to provide a range of legal and advisory services. Long-time HME industry advocate Cara Bachenheimer, who is set to open a Washington, D.C., lobbying office for the Amarillo, Texas-based law firm in June, will take the lead role representing the association’s regulatory and legislative priorities. “I have had a front-row view of Cara’s work on HME public policy issues over the years, and I have always come away impressed by her depth of knowledge and strategic thinking,” said Tom Ryan, president and CEO of AAHomecare. “She has a great sense of what can practically be accomplished on Capitol Hill and at regulatory agencies, and has a clear view of the best path forward to achieve it.”Bachenheimer has served as senior vice president of government relations for Invacare for the past 14 years.

NSM strengthens presence in NorCal

NASHVILLE, Tenn. – National Seating & Mobility has acquired Western Rehab in California. The acquisition adds locations in Santa Rosa and Paradise/Chico to NSM’s growing national network of locations. “Expanding our service reach in Northern California allows us to impact more lives with mobility solutions that drive independence,” said CEO Bill Mixon. Mark Hawkins, the former owner of Western Rehab, along with his field team, including three experienced ATPs, will stay on board to serve clients from both locations. The company, whose focus has been on pediatric complex rehab, has been in business since 1993.

Pride highlights growth at Pride Mississippi

EXETER, Pa. – Pride Mobility Products reports that its power lift recliner plant in Pontotoc, Miss., has grown to 156 employees and 240,000 square feet, making it a notable employer in the region. “When we opened Pride Mississippi, we made an investment not just in manufacturing the highest-quality power lift recliners, but also to invest in the local people of generational craftsmen who make it all possible,” said Micah Swick, director of Pride sales. “The response from our customers has been tremendous, with growth and product demand that proves the strength of made-in-the-USA manufacturing in the PLR market.” Pride Mississippi, founded in 2016, is a vertically integrated, wholly owned manufacturing facility that features sub-frame construction and hand upholstered finished work.

Soleo Health wins three Stevies

MCKINNEY, Texas – Soleo Health was named the winner of one gold and two silver Stevie Awards in the 16th Annual American Business Awards. The home infusion provider was recognized in the following categories: Gold Winner - Management Team of the Year - Business Services; Silver Winner - Company of the Year - Health Products & Services - Large; and Silver Winner – Innovation of the Year – Business Services. “We appreciate that they took the time to notice the difference Soleo Health is making in the marketplace and were able to ascertain from our entries the benefits we bring through our distinctive specialty pharmacy and home infusion services offering,” said Drew Walk, CEO of Soleo. Soleo was recognized for, among other things, navigating changes in reimbursement due to new government regulations. The winners will be honored at a ceremony on June 11.

Viemed expects to hit the TSX

LAFAYETTE, La. – Viemed Healthcare has received conditional approval from the Toronto Stock Exchange to graduate from the TSX Venture Exchange to the TSX. Final approval of the listing is subject to the company meeting certain standard and customary conditions required by the TSX by Aug. 2. Viemed expects to satisfy all requirements. “We are pleased to continue the evolution of the Viemed stand-alone entity and feel that the graduation to the TSX is an important step in that process,” said Casey Hoyt, CEO at Viemed. “As our company grows we feel that it is important to position ourselves to attract as many investors as possible, and the TSX listing should open up the doors to a brand new conversation with funds whom had prior restrictions.”

…reports ‘record’ growth

LAFAYETTE, La. – Viemed Healthcare reported revenues of $14.1 million and gross margin of $10.6 million for the quarter ended March 31, 2018, increases of 41% and 45%, respectively. The company had a working capital balance of $5.2 million and a $5 million line of credit. Adjusted EBITDA for the quarter totaled approximately $3.8 million or 27%. Viemed grew its ventilator patient count by approximately 38% compared to the same quarter in 2017. The company also completed an ongoing CMS audit. “Our patient centric company culture of always putting the patients’ needs first should lead to continuing organic growth, and this growth will ultimately lead to our company continuing to post records in both the top and bottom lines,” said Casey Hoyt, Viemed CEO, in a press release.

Compass Health snags exclusive rights to Lumin

CLEVELAND – Compass Health Brands has been tapped by 3B Medical as the exclusive distribution partner for the Lumin, a CPAP disinfection device. “The Lumin is the perfect complement to our growing line of CPAP masks, tubing, filters and other supplies, and in line with our goal of providing our dealers with a one-stop for all their product needs,” said Stuart Straus, president and CEO of Compass Health Brands. The Lumin uses high-powered, germicidal ultra violet light to neutralize and kill harmful bacteria, mold and fungus—the same disinfecting method used in operating and surgical centers around the world. It does not use harmful ozone. The device can also be used as a general-purpose disinfection system for hearing aids, dentures and even toothbrushes.

NRRTS honors CRT professionals

WASHINGTON – NRRTS recognized John Zona, ATP/SMS, as the 2018 Simon Margolis Fellow at the National CRT Leadership and Advocacy Conference in April. Zona, who has been a long-time NRRTS board member and once served as president, was honored for his significant contributions to NRRTS, the complex rehab profession and the seating and wheeled mobility community as a whole. For their support of NRRTS’s mission, the organization also recognized Julie Piriano of Pride Mobility Products for her work promoting the professional RTS through her NRRTS webinars and CEU articles; Lew Shomer, the creator and producer of the Abilities Expo, for his work advocating for people with disabilities; Angie Kiger, also for her work on NRRTS webinars and CEU articles; and Dave McCausland of Permobil for his work in government affairs.