In brief: NSM crosses border, audit targets Pacific Medical

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Friday, January 4, 2019

NASHVILLE, Tenn. – National Seating & Mobility’s presence now extends into Canada. The complex rehab provider announced Jan. 3 that it has bought SelfCare Home Health Products in Vancouver, British Columbia, its first acquisition outside of the United States. “Investing in locations outside the U.S. not only allows us to reach more clients, but also fuels continued progress in the CRT industry, both here in the U.S. and worldwide,” said Bill Mixon, NSM CEO. SelfCare is a multi-site mobility equipment and home accessibility services provider serving the Lower Mainland of British Columbia. Darryl and Kim Mackie, who have owned SelfCare since its inception in 1993, will remain with the company in a leadership capacity. The company has 60 employees in four locations, with a fifth location planned for this year.

Pacific Medical target of audit for braces

TRACY, Calif. – Pacific Medical did not always comply with Medicare requirements when billing for selected orthotic braces, according to an audit by the Office of Inspector General. For 89 of the 100 sampled claims, the company complied with requirements, but for the remaining 11 claims, it did not. Specifically, Pacific Medical billed for orthotic braces that were not medically necessary for nine claims and could not provide medical records for two claims, the OIG says. “The deficiencies occurred because the company did not always obtain sufficient information from the medical records of beneficiaries to assure itself that the claims for orthotic braces met Medicare requirements,” the audit reads. On the basis of sample results, the OIG estimates that Pacific Medical received at least $247,483 in unallowable payments. The agency recommends that Pacific Medical refund the DME MACs $247,493; exercise reasonable diligence to identify and return any additional similar overpayments outside of the audit period, in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation; and obtain as much information from medical records as necessary to assure itself that claims meet requirements. Pacific Medical did not concur with the first recommendation, but concurred with the second and third recommendations.

Aeroflow closes out big year

ASHEVILLE, N.C. – Aeroflow Healthcare says it has exceeded its goals for 2018 in sales, employee satisfaction and patient care. The launch of the Aeroflow Urology website and the Aeroflow Breastpumps Lactation Support Directory contributed to a 30% growth in revenue. Employee satisfaction increased 10%, while productivity increased 20%, according to a press release. “Aeroflow has surpassed expectations in reaching new levels of success with expansive growth and optimized patient care, all fueled by a fierce commitment to our patients and colleagues,” said Casey Hite, Aeroflow CEO and co-founder. “By investing in our team to inspire and grow talent, we’ve cultivated major ideas that have established us as a leader in health care throughout North Carolina and the rest of the country.”

Solera adds GemCare to network

PHOENIX – Solera Health has added Ohio-based GemCare Wellness to its national network of diabetes providers. Solera’s network is comprised of providers recognized by the Centers for Disease Control and Prevention as diabetes prevention program (DPP) providers. GemCare offers a personalized program focused on diet adjustments, increased physical activity and stress management. Since starting its program, most participants lost weight and 30% were no longer considered to have pre-diabetes at its conclusion, according to a press release. "One-third of adults in the U.S. have pre-diabetes, and some do not even know it," said James Piper, vice president and general manager at GemCare Wellness. "Solera shares our passion to make a difference in preventing diabetes, and through their connections with employers and health plans, we can broaden our outreach and meet patients that will realize real benefits from our program."

Contract switches to Palmetto GBA

COLUMBIA, S.C. – Palmetto GBA is taking over as the Pricing, Data Analysis and Coding (PDAC) contractor this month. The PDAC receives, evaluates and processes coding verification applications for DMEPOS; establishes, maintains and updates all coding verification decisions on the product classification list; provides coding guidance for manufacturers and suppliers on the proper use of HCPCS; maintains and publishes the NDC/HCPCS crosswalk and OACD pricing files; and conducts DMEPOS data analysis. Noridian Healthcare Solutions has held the PDAC contract since 2008. Palmetto GBA is also the National Supplier Clearinghouse and Competitive Bidding Implementation Contractor.

NHIA pushes for clarifications

WASHINGTON – The National Home Infusion Association has submitted comments to CMS asking the agency to issue sub-regulatory guidance that clarifies that home infusion services are reimbursed on any day a patient receives a professional service. The NHIA also asks the agency to establish a billing mechanism that distinguishes between professional services provided in the home by a nurse, and remote pharmacy services. “These changes would allow home infusion and homecare providers to collaborate to service patients with a homecare episode without interfering with the provision of either benefit, provide CMS with the data necessary to construct a permanent payment rate that reflects the complexity and duration of services necessary to deliver home infusion therapy, incentivize the delivery of safe, effective and high-quality care and inform future policy discussions as new and emerging medications become available,” the association states. The NHIA submitted comments in response to a final rule that CMS published in November detailing its plans to create a new home infusion therapy benefit and create a transitional payment for services.

InfuSystem’s board gets new leader

MADISON HEIGHTS, Mich. – InfuSystem Holdings has selected Scott Shuda as chairman of its board of directors. Shuda has been a member of the board since September 2015. He succeeds Gregg Lehman, PhD., who served as chairman since May 2015 and who will continue to serve on the board as vice chairman. Shuda, 53, is managing director of Meridian OHC Partners, a private equity firm that invests in small public companies, primarily in the healthcare and information technology sectors. In that capacity, he often serves as a member of the boards of directors of portfolio companies.