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by: Theresa Flaherty - Monday, February 22, 2010

What's going on over at the NSC (Not Synergistic with CMS)? We ran a story last month about providers whose Medicare supplier numbers have been in limbo for months. Some had their numbers revoked; some gave them up until they could complete their accreditation surveys or obtained surety bonds.

I have received several calls in the past couple of weeks from providers still seeking answers, or, better yet, their billing privileges. Trust me: that makes us sit up and take notice.

It would seem the NSC (Not Sure of Clarifications) ain't giving the numbers back. What's worse, providers can't even get an answer from the NSC (Now Stop Calling). Providers can call no more than once a week, but if they can't get a straight answer, what's the point?

One industry association leader, who told me she is hearing from multiple members with this problem, said when providers do get through (often a rare and special occasion) to the NSC (Not Super Clear) they get a different response each time

Providers just want to know: what is holding up those numbers or when they might get them back.

Having a problem with the NSC? You've got my number!

Theresa Flaherty

by: Theresa Flaherty - Friday, February 12, 2010

I just got my Diabetes Newswire, and the news looks grim. A few partial headlines:

"Minorities less likely to receive 'cornerstone' diabetes test"

"Eye damage from diabetes remains the leading cause of blindness'"

"'Silent strokes' linked to kidney failure in diabetics"

Good grief. Why doesn't everyone with diabetes just throw in the towel already? Of course, this gives me a chance to climb up on my  personal responsibility soapbox once again, this time to tout the importance of 1) preventing Type 2 diabetes, and 2) after a diabetes diagnosis of any flavor, taking adequate care of yourself, including testing and eating right.

Yes, I know, it's a lot more complicated than simply saying no to the birthday cupcakes that are, as I write this, being devoured in the UPub conference room. So, hats off to anyone with diabetes who manages not only to survive, but thrive with the disease. In fact, maybe next week I will feature a few here.

Theresa Flaherty

by: Theresa Flaherty - Monday, February 1, 2010

Well, Christmas Day terrorist incident aside, it looks like the airline industry takes security seriously after all. Check out this post on The writer, a CPAP user, is subjected to a "CPAP alert" when he goes through security:

I am taken off to the side and my bag is given a thorough search. The machine and all contents of my carry-on are removed, the CPAP is swabbed for explosives...and the contents are hastily returned to my bag.

Kind of embarrassing (although there are plenty more embarrassing items people get caught with, I'm sure). Not to mention, who wants their CPAP manhandled?

Maybe he should carry the CPAP in his underwear?

Theresa Flaherty

by: Theresa Flaherty - Friday, January 29, 2010

Did you listen to CMS' Open Door Forum last week? I did.

Do you remember how CMS officials said they had added 220 NPIs to the PECOS enrollment records? And how callers questioned that tiny number? And how CMS officials stood by it?

Well guess, what. Looks like that number was wrong after all. A CMS listserv forwarded to me this morning reminds folks that CMS has completed uploading 220,000 NPIs to PECOS. That's right, two-hundred-and-twenty thousand numbers, or 219,780 than they said last week.

Small wonder Medicare has so much fraud waste and abuse running rampant in its system, if numbers cause them so much trouble.

Theresa Flaherty

by: Theresa Flaherty - Tuesday, January 26, 2010

Sens. Max Baucus and Charles Grassley sent a letter to HHS Secretary Kathleen Sebelius yesterday asking her to cut some slack for pharmacies that haven't been accredited yet. The deadline for pharmacies passed Jan. 1 and with all that's happening in Congress lately, including their Christmas recess and the recent upset in the Senate, the NCPA and other stakeholders have been slowed in their efforts to get the deadline extended.

If CMS starts revoking billing privileges, beneficiaries could lose access to needed supplies, they say.

We therefore respectfully request that you use discretion in implementing the accreditation
requirement for pharmacies in a manner that preserves beneficiaries’ access to medical supplies
and equipment while Congress considers the best approach for addressing this issue.

Even if the current health reform bill goes down in flames, stakeholders expect Congress will continue to work on resolving the issue for pharmacies, based on unanimous support for the original deadline extension and broad bipartisan support for related provisions in the health care reform packages.

Theresa Flaherty

by: Theresa Flaherty - Monday, January 25, 2010

Bob Cucuel has done it again. Several years after rolling up and selling American Homecare Supply to Air Products  for the princely sum of $165 million, he's done the same thing with Critical Homecare Solutions, which BioScrips just acquired for $343 million.

Cucuel launched CHS, a home infusion provider in 2006 when he acquired Specialty Pharma and New England Home Therapies.

In October 2007, he took it public with a $125 million IPO. Fast forward a few months to February 2008, Cucuel inked a deal with MBF Healthcare Acquisition for $420 million. That deal was orginally slated to close later that summer but, after getting pushed back and then restructured the deal fell through. At the time, Cucuel told a newspaper "it's just not the time to launch a road show"to get financing.

Stay tuned for this developing story.

Theresa Flaherty

by: Theresa Flaherty - Monday, January 25, 2010

This statement caught my eye:

I supported national health insurance until I became Medicare-eligible this year.

After chuckling at that statement, I read on. It's always interesting to get a patient's perspective on the industry—its rules, its regs, its technology. In this case, the writer is a new CPAP patient. Turns out, she doesn't like having Medicare monitor how often she uses the therapy.

Medicare monitored my usage during the first month and threatened to cut me off because I wasn't using the machine enough. Ever try getting used to sleeping with a helmet at night? Not easy is putting it mildly.

Now, while most (actually all) providers would agree with her that it's a tricky therapy, they mostly tell me the policy, despite all the extra work it requires, is good medicine. They also mostly agree that if the patient isn't adhering to the therapy, taxpayers shouldn't be footing the bill.

The writer goes on to complain about the face-to-face follow-up visit.

Then, after a series of difficult procedures, tests and surgeries, Medicare threatened to cut me off again because I couldn't see my pulmonologist within a very rigid time frame. I was just too sick.

Maybe she was too sick. Maybe the policy needs a little more flexibility. Maybe she just likes to moan. I'm just glad she now has Medicare and not some government-controlled health insurance plan (insert sarcasm here).

Finally, our cranky, possibly sleep deprived beneficiary writes:

Who needs Big Brother watching my every move? Sarah Palin's "death panel" may not be as farfetched as I once believed.

Theresa Flaherty

by: Theresa Flaherty - Thursday, January 21, 2010

I just came across yet another article on Medicare fraud. The story lead off with—wait for it—a fake DME provider in Miami.

An article by Mark Potter on reads:

"After knocking on the door, calling the office number and peering through the mail slot, they found no one inside the 250-square-foot facility, which had only a desk and a few medical supplies on shelves along the wall. "The equipment on the wall certainly wouldn't justify one percent of what's billed to Medicare," said FBI Agent Brian Waterman."

Hmmm. Was there a framed accreditation certificate hanging on the wall? A copy of the company's surety bond on file so that it could bill Medicare for more than $1 million in fake claims?

Why are legitimate providers doing all that again? To prevent fraud, supposedly.

Even better, Medicare often pays dead docs for services rendered. But, if you are a legitimate provider with an order in hand from a long-time trusted referral source, you'd better not contact the patient for whom it was prescribed. At least, that's what the OIG says.

Theresa Flaherty

#HME News

by: Theresa Flaherty - Wednesday, January 20, 2010

Well now I'm thoroughly confused. I just read an article about how a new program at Walgreens that would offer face-to-face consulting services for Type 2 diabetes patients is being panned. By the medical profession.

Now, I realize there is no love lost among independent pharmacies for Walgreens. But, at the heart of the issue, isn't this sort of service supposed to  help the patients—and save the health care system money? Isn't this sort of service what's supposed to separate the good from the bad and the just plain ugly in customer service?

In fact, there has been a push in the industry for pharmacists to offer more one-on-one help, or disease state management, with the patients they see regularly. Diabetes is a natural fit. A story I wrote in August about a new program garnered several calls from providers wanting more information.

It seems the docs are afraid it will "blur the lines" of care. It doesn't sound like Walgreens or any other pharmacy would ever seek to replace a doctor's care, but rather augment, to help the patient. Let's face it: It can take months to get into see the doctor, it's more expensive and it's less convenient.

This doesn't mean I think Walgreens is being altruistic, They, like everyone else, seek to grow revenues.

With reactions like this from the medical community, I fear meaningful health care reform is a long way off.

by: Theresa Flaherty - Tuesday, January 19, 2010

Last Friday I texted my $10 donation to the Red Cross to help victims of last week's earthquake in Haiti. But, aside from the overarching needs of food/water/shelter there are bound to be large numbers of Haitians who need more specific help, including medical care and medicines for specific health conditions, like, say diabetes.

dLife, a multimedia organization geared toward people with diabetes, posted a few options for those of you who would like to donate for more specific needs. Here are two:

dLife Foundation: Supports individuals in need of diabetes supplies and education, and funds diabetes organizations with similar goals. Now through March 31, all donations to the foundation will go directly to medical relief organizations assisting Haiti.

Insulin for Life: Tax-exempt, Australia-based organization collects insulin, syringes, test strips and other supplies to people in urgent need.

And of course, there are many other groups, including Doctors without Borders, UNICEF and AmeriCares. Just make sure you know who you are donating to and that the group is reputable.

Theresa Flaherty