The year in HME News stories

Friday, December 30, 2016

YARMOUTH, Maine – 2016 was the year that HME providers fought back.

The most read story on in 2016 was “In wake of cuts, HME providers let chips fall.” When CMS implemented the Round 2 re-compete and the first phase of its nationwide rollout of competitive bidding on July 1, providers directed angry referral sources right to lawmakers. Other providers washed their hands of bid products and services—products and services that they had provided for years.

In the No. 2 spot was “Providers start dropping Medicare assignment.” A whopping 89% of the respondents to an HME Newspoll reported they had stopped taking assignment on certain products in the past year. In the No. 7 spot, another story about dropping assignment, “What are opportunities, pitfalls of billing non-assigned?”

The fighting paid off. In the No. 10 spot was “Industry gets assurance that bid relief is forthcoming,” a bellwether of what was to come in December, when Congress passed the 21st Century Cures Act, which contained a provision to retroactively delay the second phase of the nationwide rollout of competitive bidding. The bill also included a provision to delay CMS’s plan to use bid-derived pricing for accessories for complex power wheelchairs for another six months.

Not surprisingly, competitive bidding-related stories dominated much of the top 10, with “Trickle-down effect: Tricare rates nosedive” at No. 5, “Nowhere to hide: Reimbursement cuts multiply” at No. 6 and “CMS resets payment amounts for Round 2” at No.9.

Two stories about M&A activity also made the top 10: “ResMed gets ‘one-two punch’ with Brightree” at No. 3 and “Lincare offloads specialty pharmacy biz” at No. 8. It was big news—and a shock to some—when ResMed bought Brightree for $800 million. Stories in the wake of the announcement centered on the many questions the deal raised, including whether or not ResMed has direct-to-consumer plans, prompting the company to respond.

Last but not least, there was “CMS ready to roll with prior authorizations” in the No. 4 spot. This will also be a top issue in 2017: The agency announced in December that the first two codes up for the PA process will be for complex power wheelchairs and that it will apply the process in two phases in March and in July.

Happy New Year!

Here are the top 10 stories on in 2016:

No. 1: In wake of cuts, HME providers let chips fall

YARMOUTH, Maine – It’s only been a month since CMS rolled out draconian reimbursement cuts across the country, but HME providers have begun playing hardball.

No. 2: Providers start dropping Medicare assignment

YARMOUTH, Maine – HME providers are taking a hard look at what products they can continue to accept Medicare assignment on, from oxygen down the line to canes and crutches.

No. 3: ResMed gets ‘one-two punch’ with Brightree

SAN DIEGO – Some may think the price tag too high and the pairing unexpected, but ResMed officials say the company’s plan to acquire Atlanta-based Brightree makes all the sense in the world.

No. 4: CMS ready to roll with prior authorizations

BALTIMORE – CMS is moving forward with its plans to implement a prior authorization process for certain DME and stakeholders say it should make life easier for providers.

No. 5: Trickle-down effect: Tricare rates nosedive

YARMOUTH, Maine – HME providers were caught off-guard when Tricare, the healthcare program for uniformed services members and their families, began ratcheting down its reimbursement rates to below Medicare’s new reduced rates.

No. 6: Nowhere to hide: Reimbursement cuts multiply

YARMOUTH, Maine – Third-party payers have wasted no time applying recently reduced Medicare pricing, respondents to the latest HME Newspoll say.

No. 7: What are opportunities, pitfalls of billing non-assigned?

YARMOUTH, Maine – When it comes to billing Medicare non-assigned—something more and more HME providers have been forced to do—there are misconceptions about what can and can’t be done, say industry consultants.

No. 8: Lincare offloads specialty pharmacy biz

CLEARWATER, Fla., and CHARLOTTE, N.C. – National HME provider Lincare will get $75 million for its specialty pharmacy business.

No. 9: CMS resets payment amounts for Round 2

BALTIMORE – CMS today announced the new single payment amounts for the Round 2 re-compete of competitive bidding.

No. 10: Industry gets assurance that bid relief is forthcoming

WASHINGTON – HME stakeholders have House Speaker Paul Ryan’s word that Congress will take up legislation that would retroactively delay a recent reimbursement cut in non-competitive bidding areas in a lame-duck session after the elections.