In brief: PMD hearing, LCD update, ASP figures

Friday, September 14, 2012

WASHINGTON – A Senate Aging Committee hearing this week will focus on new Medicare prior authorization requirements for power mobility devices (PMDs). The hearing, scheduled for Wednesday, Sept. 19, at 2 p.m., will review a three-year CMS demonstration project requiring prior authorizations for PMDs in seven states. The states under the microscope—California, Illinois, Michigan, New York, North Carolina, Florida and Texas—are where government officials believe PMD fraud is most prevalent. A 2011 Office of Inspector General report found that in these states, which together account for 43% of annual Medicare spending on PMDs, 80% of PMD claims did not meet Medicare criteria and should not have been paid. For the most part, industry stakeholders support the prior authorization requirements because they mean providers or physicians will get approval for claims before delivery of equipment. Read more on the PMD demo:

Oxygen LCD gets updated

NASHVILLE, Tenn. – CGS, the DME MAC for Jurisdiction C, posted changes to the local coverage determination (LCD) for oxygen on Sept. 13. Two big changes: exercise testing must be supervised by a physician or other qualified individual; and home sleep testing requirements are limited to standalone overnight pulse oximetry. The revised LCD goes into effect Oct. 1, 2012. FMI:

Few changes in new ASP figures

BALTIMORE – The new average sales price (ASP) figures for nebulizer medications released last week brought few changes. Albuterol (J7613) was down 2 cents to 13 cents per dose, while budesonide (J7626) was down nearly 11 cents to about $4.87 per dose. Levalbuterol (J7614) and ipratropium (J7644) stayed flat at 65 cents and just under 13 cents per dose, respectively. Brovana (J7605) was down almost 14 cents per dose to $5.22, and Perforomist (J7606) was up just more than 12 cents per dose to $5.21.

Complex rehab bill gains congressional support

WASHINGTON – Two more members of Congress are co-sponsors of legislation that would create a separate benefit for complex rehab. The two most recent co-sponsors of H.R. 4378, the “Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012,” are Reps. Cathy McMorris-Rodgers (R-Wash.) and Diane Black (R-Tenn.), according to an update from NCART. McMorris-Rodgers serves on the House Energy and Commerce Committee and is the Republican chairwoman of the House Bi-Partisan Disability Caucus. Black serves on the House Ways and Means Committee and, prior to getting elected to Congress, had a career as a nurse.

CGS retains Medicare contract

NASHVILLE, Tenn. – CGS Administrators LLC (CGS) will remain the DME MAC for Jurisdiction C, according to a news release from the company. The contract, valued at more than $170 million, includes a base year starting Sept. 1, 2012, and four option years. The company will maintain current staffing levels in both its headquarters, based here, and its offices in Des Moines, Iowa, and High Point, N.C. Jurisdiction C, the largest of four DME MAC jurisdictions in the United States, represents more than 37,000 Medicare suppliers and more than 13 million Medicare beneficiaries. The jurisdiction includes 16 states and the U.S. Virgin Islands.

USM buys Glass Seating

ST. LOUIS – United Seating & Mobility (USM) has acquired Glass Seating & Mobility, according to a press release. Bob Guoy, president and CEO of USM, a mobility and rehab equipment supplier based here, stated that the transaction will add the state of Alabama to the company’s service area, and will strengthen the company’s existing teams in Tennessee and Arkansas. Glass Seating & Mobility President Teresa Owens will become the regional manager for the mid-South area and her associates will join the company in Memphis, Tenn.; Little Rock, Ark.; and Huntsville, Ala.

Patient recruiter sentenced for fraud scheme

WASHINGTON ­– A patient recruiter was sentenced last week to serve 18 months in prison for her involvement in a Medicare fraud scheme. Karen Rayburn, 47, a recruiter for several Louisiana DME companies, was one of several people who took part in a scheme involving fraudulent claims and illegal kick back payments for unnecessary DME, according to the Department of Justice. Between 2004 and 2009, Rayburn allegedly obtained information from Medicare beneficiaries and falsified prescriptions for medical equipment, which she then submitted as fraudulent claims to Medicare. In addition to her prison term, Rayburn was ordered to pay $3.18 million in restitution and sentenced to two years of supervised release. Eight other defendants have been sentenced for taking part in the scheme, and three additional defendants await sentencing.

Fastrack and Graham-Field integrate

PLAINVIEW, N.Y., and ATLANTA – Graham-Field announced this week that its product catalog and dealer price list will be integrated into Fastrack Healthcare Systems’ inventory management and e-commerce modules. The integration will make an HME provider’s inventory management and online ordering capabilities more efficient, according to a press release from Graham-Field. The companies will debut the system at Medtrade 2012 in Atlanta.

Did you use group name and NPI?

BALTIMORE – The DME MACS will be contacting HME providers that submitted claims using both a group name and national provider identifier (NPI) as the ordering NPI for ordered or referred services, according to a bulletin last week. The physician’s name and NPI, not a group name and NPI, must be used as the ordering name and NPI on the claim. Once CMS turns on the edits for ordering/referring services, claims using a group NPI will be denied.