In brief: OIG targets orthotics and vents, Rep. Tipton throws support behind rural providers

Friday, November 6, 2015

WASHINGTON – Orthotics and vents are among the HME that the Office of Inspector General plans to focus on in fiscal year 2016, according to a work plan published last week.

The OIG plans to determine the reasonableness of Medicare fee schedule amounts for orthotic braces. The agency will compare Medicare payments made for braces to amounts paid by non-Medicare payers to identify potentially wasteful spending. It will also estimate the financial impact on Medicare and on beneficiaries of aligning the fee schedule for braces with those of non-Medicare payers.

Also for orthotics, the OIG plans to review Medicare Part B payments for braces to determine whether the claims of DME providers were medical necessary and were supported in accordance with Medicare requirements. Prior work by the OIG has indicated that some providers were billing for services that were medical unnecessary or were not documented in accordance with Medicare requirements.

The OIG also plans to describe billing trends for vents, RAD and CPAP devices from 2011-14, as well as examine factors associated with the increase in vent claims. From 2013-14, there has been a 127% increase in allowed amounts for E0464, and during that same period, the number of beneficiaries receiving the devices increased from 8,633 to19,085. The OIG says providers may be inappropriately billing for vents for beneficiaries with non-life threatening conditions, which would not meet the medical necessity criteria for vents and might instead be more appropriately billed to codes for RADs or CPAPs.

In addition to orthotic braces and vents, the OIG plans to examine provider compliance with payment requirements for power mobility devices, and nebulizer machines and related drugs.

The agency also plans to examine the effectiveness of system edits to prevent inappropriate payments for blood glucose test strips and lancets to multiple providers, and access to DME in competitive bidding areas.

Rep. Tipton throws support behind rural providers

WASHINGTON – Rep. Scott Tipton, R-Colo., is collecting signatures for a “Dear Colleague” letter that asks for legislative relief from impending Medicare cuts for HME providers in rural areas, VGM announced yesterday.

On Jan. 1, CMS plans to apply bid pricing in non-bid areas. Though pricing will be slightly higher in rural areas, the agency intends to use regional prices limited by a national ceiling (110% of the average of regional prices) and floor (90% of the average of regional prices).

“There are already larger barriers to access for home health services in rural parts of the country, and decreasing compensation for the services required to deliver equipment to this area reduces the likelihood that providers will continue to operate there,” wrote Tipton.

Tipton noted that the 10% adjustment to reimbursement in rural areas will not cover the cost of services provided and questions whether CMS’s phase-in timeline is realistic. He also highlighted concerns about the potential impact the cuts will have on beneficiary access.

VGM encourages stakeholders to contact their representatives and ask them to sign on to the letter by Nov. 16before it makes its way to leaders of the House Ways and Means Committee.

Max Mobility gets smarter

ANTIOCH, Tenn. – Max Mobility has created a new position, SmartDrive Educator, and has named Devon Doebele, the Florida territory manager for MSL Associates, to fill it. He will oversee the strategic direction, expansion and education of the company’s SmartDrive wheelchair power assist technology, working with manufacturers like Easystand, Ki Mobility, Roho and TiLite. Doebele will be a member of the company’s executive team and report to President Mark Richter.

Mediware stands by existing platforms

LENEXA, Kan. – Mediware will not “sunset” any of its existing platforms in the near future, it told its providers customers in an email blast last week. “We are allowing customers to plan and prepare for any future migration, which we anticipate will occur over several years,” the company stated. “In the meantime, we continue to invest in and update our established products with regulatory revisions, defect changes and enhancements, as required.” In the past few years, Mediware has acquired a number of platforms from different software vendors, including Definitive Homecare Solutions, Fastrack and CareCentric.

Former Numotion execs launch company

HARTFORD, Conn. – Well-known industry execs Paul Bergantino and Tim Burfield have launched Lifeway Mobility, which will provide home accessibility equipment like ramps, lifts and bath safety solutions. Bergantino, president of Lifeway, has held several high-profile positions, most recently CEO of Numotion. He also spent five years as CEO of ATG Rehab; Numotion was formed when ATG Rehab and United Seating & Mobility merged in 2013. Burfield, chairman of Lifeway, has worked side by side with Bergantino, holding the CEO post at ATG Rehab prior to Bergantino, and serving as a director at Numotion. "Paul and I look forward to building another company that will enhance the wellbeing of those who face extraordinary challenges every day from the effects of accidents, illnesses and aging," Burfield stated in a press release.

NSM makes second buy of year

NASHVILLE - National Seating & Mobility has acquired Garden City, N.Y.-based Home Medical Equipment, the provider announced this week. HME provides seating and mobility systems and home accessibility equipment to all five New York City boroughs. “As we continue to grow our footprint in the Northeast, we’re pleased to add the expertise and dedication of all the HME staff members,” said Bill Mixon, president and CEO of NSM. “Bill (Tobia) and his team have created a great company that we are proud to bring into the NSM family.” Prior to HME, NSM’s most recent acquisition was Denver-based USA Mobility in June.

BioScrip shows progress

ELMSFORD, N.Y. – BioScrip today reported third quarter revenues from continuing operations of $247.3 million, a 6.8% increase over the same period last year. Gross profit was $63.1 million, a 3.9% increase, and net loss was $24.2 million, the company reported. BioScrip announced last quarter that it was refocusing on its core infusion business. It sold its non-core pharmacy benefit management business for $25 million, and reduced its workforce by 12%.

Medtrade exhibitors snag product, booth awards

ATLANTA – Before Medtrade closed on Thursday afternoon, show organizers bestowed awards on several exhibitors for their products and booths. The Providers Choice Gold Award went to Urifunnel, a product that enhances bathroom sanitation and safety; The Providers Choice Silver Award to EZ-Sit, a product that attaches “arms” to an armless chair, helping the user to stand independently; and the Providers Choice Bronze Award to College Canes, canes decorated with college logos. The Best Booth Award went to Mediware, and the Creative Concept Booth Award went to McKesson Medical-Surgical.

Renfro launches wholesale website for hosiery

MOUNT AIRY, N.C. – Renfro in October launched an online store ( to provide licensed medical professionals and businesses the opportunity to order hosiery for a variety of medical conditions. While product information on the website is viewable by anyone, medical professionals must request an account to access wholesale pricing and place an order. Once the account is approved, professionals can log in anytime to place orders using a credit card. Orders ship between two to three business days. “The new website gives medical offices, pharmacies and medical supply retailers a quick and easy way to order new or replenishment stock of all our medical hosiery,” said Brad Ballentine, senior vice president. “They can order 24/7 from any device, including desktop and mobile device.” All hosiery is produced under the Dr. Scholl’s or Copper Sole brands.

Sigvaris marks start of expansion

PEACHTREE CITY, Ga. – Sigvaris held a groundbreaking ceremony on Nov. 2, kicking off its plans to build a 40,000-square-foot facility with office, manufacturing and warehouse space. The new North American headquarters will allow Sigvaris to move manufacturing, warehouse and customer care all under one roof. Currently, the company occupies two locations. Sigvaris expects the expansion to provide growth opportunities for 10 years and create more than 70 new jobs.

Short takes: Medtrade, ING Source, Laboratory Tactical, TiLite, BOC

Attendance for Medtrade, held Oct. 26-29 in Atlanta,was up overall. Registration for educational sessions was up 17%, while non-exhibitor attendance was up 1% compared to last year...ING Source’spending patent application for the FS6 Compression Foot Sleeve has been approved by the U.S. Patent and Trademark Office. “We can now aggressively protect the invention and market creation for which we are so proud, but more importantly, protect the consumers from ineffective look-a-likes and imitators," said CEO Dave Higgins, in a press release…Laboratory Tactical Consultinghas named Bryan Hines COO. Hines previously lead Genpact’s venture into health care and will be responsible for development and operational excellence across the company…More than 50 TiLite employees participatedin the Trios Health Tri-Cities Marathon on Sunday, Oct. 26. Employees worked in teams of four, with each person rolling about 6.5 miles…Claudia Zacharias, president and CEO of the Board of Certification/Accreditation, recently took over as chairwoman of the Institute for Credentialing Excellence (ICE) board of directors. ICE is a professional membership association that advances credentialing through education, standards, research and advocacy.