In brief: Senators question TSS, PMD demo goes online

Friday, January 11, 2013

WASHINGTON – A pair of U.S. senators have some hard questions for CMS regarding overpayments to The Scooter Store. Among them: Does CMS plan to recoup more of what it’s owed by the power wheelchair provider? “It is unclear why CMS accepted a significantly lower repayment amount than the overpayments initially identified by independent audits under (its corporate integrity agreement),” Sens. Richard Blumenthal, D-Conn., and Herb Kohl, D-Wis., stated in the letter. In April 2011, after an independent audit, The Scooter Store notified CMS of overpayments ranging from about $32 million to $64 million, according to the letter. In November 2011, the company notified CMS of another round of overpayments ranging from about $14 million to $24 million, it states. After analyzing the findings of the audits, The Scooter Store determined an overpayment of $19.5 million. But because the company could not pay that amount, it proposed a payment schedule to CMS and the Office of Inspector General (OIG), according to the letter. “Why did CMS accept the repayment amount of $19.5 million, which is significantly less than overpayments identified?” the letter states. “Was a greater amount or longer-term repayment schedule discussed?” The senators also want to know, at this point in the repayment schedule, whether The Scooter Store has “fulfilled its obligations and made the repayments in a timely manner” and whether CMS plans to take further actions to “compel The Scooter Store to repay more of the total overpayments beyond the $19.5 million.” Sens. Blumenthal and Kohl say they would like a response from CMS by Jan. 14.

CMS expands online submission for PMD demo

WASHINGTON – Jurisdictions A, C and D are now accepting PMD prior authorization requests online through the electronic submissions of Medical Documentation (esMD) system, according to a CMS announcement. The move is designed to reduce provider costs and cycle time by minimizing and eventually eliminating the paper processing and mailing of medical documentation to review contractors, the announcement said. A secondary goal is to reduce the costs and time of review contractors. Using esMD is voluntary. Providers who prefer to fax or mail documentation to review contractors may continue to do so.

RAC hits $1B in corrections

NEW YORK – A Medicare Recovery Audit Contractor (RAC) has reached the $1 billion mark in corrections for overpayments and underpayments, according to a press release. HealthDataInsights (HDI), a provider of recovery auditing services for Medicare, Medicaid and other healthcare payers, is the Medicare RAC for region D, which includes 17 states and three territories. HDI has generated 36% of all corrections to date, according to the release. “CMS’s Comprehensive Error Rate Testing Report, released in November 2009, reported the improper payment rate was 8.6%, representing $28.8 billion in improper payments,” stated Andrea Benko, president of HDI, in the release. “We’re proud to recover a fraction of those dollars so Medicare can do more for those who need help the most.” HDI reached the $1 billion mark about four years after the RAC program’s inception in 2009.

HomeTown Oxygen receives $4M investment

NEW YORK ­­– Enhanced Small Business Investment Company (ESBIC) has provided $4 million in senior secured debt financing to Charlotte, N.C.-based HomeTown Oxygen, according to a press release. A provider of respiratory products and services, HomeTown will use the investment to continue its expansion. “This financing will allow HomeTown Oxygen to continue the growth of its respiratory business and expand into new locations,” stated Scott Dinning, CEO of HomeTown. ESBIC makes debt and minority equity investments in U.S.-based, lower middle market companies across most sectors, according to its website.

OIG: Premier submitted ‘unsupported’ claims for prosthetics

WASHINGTON – Of 100 sampled claims for lower limb prosthetics submitted by Premier Prosthetics and Orthotics, a provider based in Creve Coeur, Mo., 43 claims were either not supported or only partially supported, according to the Office of Inspector General (OIG). The OIG believes, based on this sample, that the unsupported claims resulted in overpayments of $284,023 from Jan. 1, 2010, through Dec. 31, 2011. Of the 43 claims that did not conform to the requirements, the majority (35) lacked documentation in the medical records to support medical necessity. The OIG recommends that Premier refund $284,023 to the federal government, and strengthen its internal controls by implementing policies and procedures to ensure it collects and maintains the required documentation.

Highest tech honor goes to AirSep developer

AMHERST, N.Y. – Norman McCombs, senior vice president of research and development at AirSep, received the National Medal of Technology and Innovation from the U.S. government, according to a press release from SUNY Buffalo, where McCombs is an alumnus. The award recognizes those “who have made lasting contributions to America’s competitiveness and quality of life and helped strengthen the nation’s technological workforce.” McCombs, who has been associated with AirSep since the company’s inception in 1986, helped develop the first oxygen concentrator to treat people suffering from chronic obstructive pulmonary disorder (COPD), according to the release. The original device, developed by McCombs in the 1960s after he figured out a new way to separate gases, weighed more than 200 pounds. Today, oxygen concentrators make up a $2 billion market, according to data from the Department of Commerce, insurance companies and medical equipment providers.

Roscoe products to be featured on The Dr. Oz Show

STRONGSVILLE, Ohio – Two pain relief products from Roscoe Medical will appear as “no-pill pain busters” on an episode of The Dr. Oz Show scheduled to air Friday, Jan. 11, the company told HME News. The products—the UltraTENS and the InTENSity 10—are pain relief devices that employ two different methods of therapy. The UltraTENS is a deep heat ultrasound device designed to treat chronic and acute muscular pain, while the InTENSity is a targeted electrotherapy unit for joint and back pain.

National Incontinence opens new office

FULTON, Md. – National Incontinence has moved into a new corporate office in Fulton, Md., according to a press release. The office is three times larger than the company’s original location in Ashton, Md. “After eight years in our location, we were really maxed out,” stated Renee Mercer, president of the company.“We hadrun out of space in the warehouse, call center, and IT office. We didn't think that our business would expand this fast.” The new office includes a large call center, additional workspaces and a warehouse with more inventory space.

Convaid employees received child safety certifications

TORRANCE, Calif. – Convaid is having their business development representatives get nationally certified as Child Passenger Safety Technicians (CPST), according to a press release. The decision comes after the company started carrying the Carrot 3, a special needs car seat restraint system. “I wanted to make sure our staff is well-educated on the matter and can assist our customers without any problems,” stated Chris Braun, president of Convaid. With the certification, Convaid representatives can educate parents and caregivers on crash dynamics and injury prevention strategies, and help them secure their children in the correct restraint with hands-on assistance.

CareCentrix moves headquarters

HARTFORD, Conn. – CareCentrix Inc., which coordinates home medical equipment and other services, has relocated to Hartford, Conn. The new location, which spans 30,000 square feet, is designed to accommodate CareCentrix’s growing workforce. The company has more than tripled its workforce since 2008 to 240 employees today, according to a press release. The company said it will add more than 100 employees in their Hartford location in 2013, and it plans to add more than 300 new jobs over the next five years.

Healthcare spending stayed low in 2011

WASHINGTON ­– Healthcare spending in the United States grew at a rate of 3.9% in 2011, continuing a recent trend of extremely slow growth, according to a new analysis from the Office of the Actuary at CMS, which was published in the January 2013 issue of the journal Health Affairs. The annual growth rate of 3.9% is identical to spending growth rates in 2009 and 2010, which means that growth in all three years has occurred at the slowest rates ever recorded in the 52-year history of the National Health Expenditure Accounts. Total healthcare spending growth in 2010 and 2011 tracked closely national GDP growth, and the health spending share of GDP remained stable in 2011 at 17.9%. Spending for Medicare, private health insurance and consumer out-of-pocket payments increased faster in 2011 compared to 2010, although Medicaid spending grew more slowly, according to the analysis. The Affordable Care Act’s affect on aggregate health spending in 2010 and 2011 was “minimal,” though certain subcomponents of national health expenditures, such as private health insurance spending, were impacted.

AAH: HME spending ‘not out of control’

WASHINGTON – New national health expenditures data released by CMS shows that HME continues to shrink as a proportion of total Medicare spending, according to a bulletin from AAHomecare. The 2011 data reveal that while Medicare spending is increasing, HME spending dipped to about 1.39% of total Medicare spending—the lowest percentage in the past 10 years, the association states. Across the entire healthcare system, HME spending increased by 5.42%, from $36.9 billion to $38.9 billion, reflecting a growing demand for HME and related services. “So again, it is clear that HME spending in Medicare is not ‘out of control,’” the bulletin states. “In fact, as policies continue to squeeze HME reimbursements, Medicare spending on HME is likely to remain nearly flat and continue to fall as a proportion of total spending, even in the face of increasing demand.”