In brief: Relief payments begin, private insurers relax requirements

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Friday, April 10, 2020

WASHINGTON – CMS has begun making an initial $30 billion in relief funding available to hospitals and providers as part of the national response to the coronavirus pandemic.

The funding is part of the $100 billion in relief funding to providers called for in the CARES Act recently passed by Congress.

This initial, broad-based distribution will go to hospitals and providers across the U.S. that are enrolled in Medicare. Hospitals and providers are allotted a portion of the $30 billion based on their share of 2019 Medicare fee-for-service reimbursements.

Providers will be paid via automated Clearing House Account information on file with UnitedHealthcare Group, UnitedHealthcare or Optum Bank, or used for reimbursements from CMS.

Within 30 days of receiving payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The portal for signing these attestations will be open the week of April 13.

Private insurers relax requirements
WASHINGTON – Humana, Anthem and United Healthcare have updated their payments and policies amid the coronavirus outbreak, AAHomecare reports.

For members with a COVID-19-related diagnosis, Humana is now: covering short-term oxygen use, waiving the signature-at-delivery requirement for DME, waiving all out-of-pocket medical costs related to treatment, increasing flexibility around telehealth for physician office visits, and suspending medical records requests for pre- and post-paid claim review processes.

“The changes follow strong outreach from AAHomecare and other industry stakeholders on many of these issues,” the association said.

Anthem is now: suspending select prior authorization requirements to allow providers to focus on caring for patients diagnosed with COVID-19, and temporarily adjusting its approach to monitoring claims and audits.

UnitedHealthcare:
•    For all COVID-19 discharges to home-based care requiring a respiratory assist device or a ventilator, the vendor can deliver on notification only to UnitedHealthcare for codes E0471, E0465, E0466 and E0467 for up to three months from time of delivery. Notification is requested and the claim must be submitted with the appropriate modifiers and diagnosis code (ICD-10). After the three-month period, a prior authorization will be required.
•    For orders involving COVID-19-related oxygen requests, oxygen can be delivered without prior authorization and does not need to meet current clinical criteria.
•    Extends certain prior-authorizations and allows for face-to-face exams by telehealth for new prior authorizations.
•    Allows larger supply amounts for these disposable supply codes.
•    Relaxes proof-of-delivery requirements.

Providers asked to do the right thing
WASHINGTON – Industry stakeholders, including AAHomecare and VGM, are urging providers to use their best judgment when applying new guidance from CMS.

CMS has relaxed certain Medicare criteria to make it easier to treat patients during the coronavirus pandemic.

“It is critical that HME providers not use the relaxed requirements to engage in fraudulent and/or unethical acts designed solely to generate revenue,” stated AAHomecare in a letter to the industry. “We are all in this together, and there is no room for any type of questionable behavior.”

CMS has relaxed various criteria for respiratory and sleep orders, including eliminating the chronic stable state requirements. It has also relaxed signature, documentation and testing guidelines.

Providers are urging providers to police themselves. VGM’s Clint Geffert, in a letter to the industry, reminded providers of the Fraud Eradication Advisory Team, which has a website and electronic reporting tool for confidentially reporting suspected fraud or abuse of the Medicare program.

“If you suspect a supplier, physician, clinician, manufacturer or other entity is committing an act of fraud, we ask that you act and report them now,” he said.

Once the public health emergency declaration is lifted, Medicare policies will be reinstated, audits will return and claims submitted during this time may be scrutinized at some point in the future, says Wayne van Halem. It is likely that patients who received equipment during the PHE will have to be re-qualified.

“It is up to us to track monitor and control what we do at this time, not only for the good of the industry, but also because of our shared responsibility in protecting the Medicare Trust Fund,” he said.

CMS allows upgrades to multi-function vents
WASHINGTON – CMS has allowed for expanded use of multi-function ventilators (E0467), according to an MLN Matters article.

“Effective immediately, you may provide and bill for multi-function ventilators described by code E0467 as an upgrade in situations where beneficiaries only meet the coverage for a ventilator,” the article states.

Previously, to meet the medical necessity coverage for multi-function vents, CMS required beneficiaries to need a ventilator and at least one of the four additional functions (oxygen concentrator, cough simulator, suction pump and nebulizer).

If providers want to collect the additional charge for the upgrade, they must obtain a properly completed advance beneficiary notice (ABN) and bill using the GA and GK modifiers. If not, they must bill with a GL modifier.

NHIA asks for bundled payment
ALEXANDRIA, Va. – The National Home Infusion Association says CMS’s interim final rule doesn’t go far enough to preserve access to home infusion therapy.

“In our view, the CMS interim final rule does not establish a practical path forward for the thousands of patients who depend on IV therapies to manage their clinical conditions at home,” the association states.

The NHIA argues that the IFR’s expansion of telehealth and broadening of clinical indications for a limited number of Part B DMEPOS drugs won’t generate significant access to home infusion for seniors who need to avoid being exposed to the coronavirus.

Instead, the association makes the case for establishing a bundled payment for professional services, supplies and equipment—similar to the commercial payer model—that is paid to home infusion providers for each day of infusion.

The NHIA says CMS should move quickly to leverage these clinicians and help beneficiaries get the medications they need at home.

“Now more than ever we need practical solutions based on proven methodologies to create home infusion access,” said NHIA President & CEO Connie Sullivan. “This rule will not relieve the burden facing health systems or provide viable alternatives for seniors.”

Viemed Healthcare increases guidance
LAFAYETTE, La. – Viemed Healthcare now expects 2020 net revenues to be about $23.7 million to $23.9 million as a result of increased sales of ventilators.

The company is fulfilling ventilation orders in the more severely COVID-19 impacted areas of Louisiana and New York, and anticipates fulfilling a larger amount of orders during the second quarter.

“We recognize that being one of the largest home-based ventilator companies in the country puts us in a unique position to help with the current pandemic,” said CEO Casey Hoyt. “We have long said our ventilator inventory and our network of respiratory therapists around the country are our two largest assets. Our team is working tirelessly on all potential solutions to help the government and health systems during this COVID-19 crisis.”

Viemed says sales of previously used equipment will be recognized in gain on disposal of property and equipment in its financial statements and is currently estimated to be approximately $1.4 to $1.5 million.

The company also says its patient attrition rate has not been negatively impacted by the company modifying its clinical protocols to limit unnecessary patient encounters. 

“I am very proud to see that the quick actions we have taken so far appear to be keeping our growing patient base comfortable in their homes and our employees safe, and there appears to be only positive impacts from our modifications of the treatment regimens,” Hoyt said.

Reliable Medical Supply grows mobility business
MINNEAPOLIS – Reliable Medical Supply, a provider of complex rehab technology, clinical respiratory products, and DME and supplies, has announced a partnership with A&A Medical Supply. As part of the partnership, A&A’s management team, including Anton Yeranossian, founder and CEO, will become investors in RMS and will continue to help grow the combined company. “When we decided to launch an aggressive growth plan in late 2019, we targeted companies who share the same patient-centric attitude that has led to RMS’s success,” said Debra Kalk, CEO of RMS. “By partnering with Anton and his team at A&A Medical, I am confidence we can continue to improve care solutions across the Midwest.” Chagrin Falls, Ohio-based A&A Medical provides various levels of mobility equipment, from a basic wheelchair to complex rehab technology. In November, RMS announced a recapitalization of its equity by Seven Hills Capital, a Chicago-based private equity firm.

Quantum offers free webinars
EXETER, Pa. – Quantum Rehab is offering free live educational webinars for CEU credits through the Pride Learning Institute. Topics include seating and positioning, pediatrics, bariatrics, drive controls, drive-wheel configuration, power seating and more. “The Quantum education team has been hard at work developing our complimentary CEU webinar series,” said Julie Piriano, vice president, clinical education/rehab industry affairs & compliance officer at Quantum Rehab. “Classes are being held several times a day to make it easy to fit the schedules of ATPs and clinicians.” Go here to view available webinars and their dates and times, course descriptions, learning objectives and instructor information, as well as to register.

Sunrise Medical provides access to worldwide educators
FRESNO, Calif. – Sunrise Medical is launching a new live webinar series from a team of worldwide clinical educators through its Education in Motion Resource. A series of six live free webinars will launch on April 15, one a week for six weeks. “These engaging, live webinars will be infused with relatable real-life examples from the educators, paired with the knowledge that comes with years of clinical experience,” the company said. “Participants will also have the opportunity to ask questions in these interactive webinars.” On-demand webinars are also available.

Quality Biomedical opens in Indiana
BOULDER, Colo. – Quality Biomedical has opened its 7th respiratory equipment service center in Fort Wayne, Ind. The new center will allow the company to serve a growing customer based in the Midwest, reaching the Chicago area to the West and into Ohio and Michigan to the East. “This is another step in our company’s goal to be the first respiratory equipment service-management company with a national footprint,” said PK Bala, CEO. “This is a tremendous value-add for our OEM and HME partners, as they strive to improve operational efficiency by reducing the number of vendors and equipment service partners they work with.” Quality Biomedical specializes in warranty and non-warranty service and management for oxygen concentrators, POCs, ventilators and other respiratory, enteral and infusion-related products.

CMS approves billions in advance payments
WASHINGTON – CMS has approved $34 billion in accelerated/advance payments for Medicare providers for the first week of April. The streamlined process implemented by CMS for COVID-19 has reduced processing times for a request of an accelerated or advance payment to between four to six days, down from the previous timeframe of three to four weeks. In a little over a week, CMS has received more than 25,000 requests from health care providers for accelerated and advance payments, and has already approved more than 17,000. “Health care providers are making massive financial sacrifices to care for the influx of coronavirus patients,” said CMS Administrator Seema Verma. “They shouldn’t be penalized for doing the right thing.”

DHHS awards vent contract to Philips
MURRYSVILLE, Pa. – The Department of Health and Human Services has awarded a contract for ventilator production under the Defense Production Act (DPA) to Philips. Per the $646.7 million contract, Philips has agreed to produce 2,500 ventilators for the Strategic National Stockpile by the end of May 2020 and a total of 43,000 ventilators to be delivered by the end of December 2020.“HHS will continue awarding contracts to companies for which it has invoked the DPA for ventilator production, while we explore every possible avenue to get life-saving supplies to the frontlines of this war on the virus,” said HHS Secretary Alex Azar. President Trump invoked the DPA April 2.

VGM addresses impact of coronavirus pandemic
WATERLOO, Iowa – The economic impact of the coronavirus pandemic has led the VGM Group to eliminate 68 full-time employees. The adjustments impacted all of VGM’s 12 locations nationwide and each division of the employee owned company. VGM has also offered 17 full-time employees transfers within the company, extended furloughs or accelerated retirement. Additionally, 15 part-time employees were impacted. “The COVID-19 pandemic has caused a very challenging time for our employees, customers and communities we serve and has caused us to make some very difficult decisions about our workforce,” said CEO Mike Mallaro. “Although this is very difficult for everyone in the VGM family, these actions are necessary.” VGM says 98% of the company’s employees who work in office-related roles have converted to working from home. The remaining employees work in one of three warehouses in Waterloo, Nashville, Tenn., or Phoenix. The company in February formed a Pandemic Response Task Force to keep employees safe and informed. The task force has enacted a number of procedures and policies, including the option to work from home, shift separations, and increased cleaning and sanitizing of common areas. “During this unpredictable crisis, significant adjustments were implemented to protect the physical health and safety of our employee-owners and immediate actions were taken to allow us to continue to serve our customers across the country,” Mallaro said. “Our task force continues to monitor this ever-changing situation.” 

Sego’s wears role proudly
CASSELBERRY, Fla. – Employees at Sego’s Home Medical Equipment are wearing T-shirts that say “HME providers on the front lines; HME providers keep patients at home.” Lindsay Sego says the current coronavirus pandemic shines a spotlight on the important role of HME providers. “We are keeping people in their homes with the medical support they need and out of our hospitals, which is central to overcoming this pandemic without crippling our hospital systems,” she said. Gene Sego added: “These are uncertain times, but there is one thing that is certain: HME providers are a critical piece of the health care continuum and my company, like so many other providers across the country, will see this through and look forward to healthier days ahead,” he said.

WellSky extends offerings
OVERLAND PARK, Kan. – WellSky has introduced a new virtual visit technology collaboration with Synzi, offering clients a free trial with access to a range of capabilities. Among those capabilities: video visit technology that empowers real-time visits between clinical staff and patients or case mangers and their clients. “WellSky is fiercely protective of our clients and the communities we serve always, and especially now as the COVID-19 outbreak progresses,” said Bill Miller, CEO of WellSky. “Our clients are facing never-before-seen challenges, and we’re here to equip them with the technology they need to safely administer care anywhere. For the duration of this pandemic and far beyond, WellSky is dedicated to removing barriers to care and delivering the right solutions when, where, and how our clients need them.” WellSky has also announced a new agreement to deliver Kno2’s Interoperability as a Service and record-request technology at no charge, and extended complimentary access to its CareInsights predictive analytics technology to clients.

NSM expands in Arkansas
NASHVILLE, Tenn. – National Seating & Mobility has acquired A Plus Medical Supply in Little Rock, Ark., boosting its presence in the state. “The team at A Plus Medical Supply shares our commitment to client care,” said Bill Mixon, NSM CEO. “We look forward to expanding offerings for individuals in need of independence solutions in this community.” A Plus Medical Supply offers both complex rehab technology and disposable medical supplies. Danny Petty, the former owner of the company and an ATP, will join NSM as branch manager and practicing ATP, along with one RTS.

AAH honors HME on the frontlines
WASHINGTON – AAHomecare is encouraging those in the industry to download and use an image that thanks respiratory therapists, HME providers, manufacturers, delivery techs and support services for making a difference amid the coronavirus outbreak. “Thank you to our incredible members who are essential workers in this fight,” the association says. “You are making an immense difference in the lives of families each day.” Download the image here.