Archive: March 2004

NEW BRAUNFELS, Texas - The Scooter Store, the nation's largest provider of power mobility products, recently announced that it had earned accreditation from the Accreditation Commission for Health Care (ACHC). The Scooter Store earned the distinction following a seven-month process that required compliance with 58 standards covering eight areas of business operation. ACHC also conducted several unannounced visits of Scooter Store locations. “Particularly because of the situation that emerged...

YARMOUTH, Maine - When Steve Awtry learned in October that CMS had asked his employer, Home Health Options, to repay $157,000, his jaw dropped. His eyes lit up. He couldn't believe it. Les Defelice “Two and a half employees and we get a $157,000 bill?” said Awtry, who works part time and handles a variety of duties. “It was earth shattering. I thought that was it.” It wasn't. Owner Russ McLellan put his wedding on hold because of the uncertainty, but he managed to hold the...

WASHINGTON - Medicare officials may claim that beneficiaries and mom-and-pop providers aren't being seriously affected by the DMERCs' crackdown on power wheelchair utilization. Don't, however, tell that to small rehab providers like Jeff West, Tyrrell Hunter and Russ McLellan. If you do, they may tell you to go jump in a lake. CMS's all-out effort to rein in power chair fraud following September's Wheeler Dealer scandal has left providers like these three jittery and, in some instances, on the brink...

LAS VEGAS - New surprises and challenges popped up in every corner of the DME industry last year, from the passing of the Medicare Prescription Drug Act to the average sales price's creation to the DMERC clarification of non-ambulatory. Las Vegas is the site of Medtrade Spring and AAHomecare's Continuum of Care conference, March 16-18. Now, with Medtrade Spring at our doorsteps, it's time to regroup. “Unfortunately, when you are an HME provider you don't have a huge network at home, especially...

Judge sees differences between Escort & Helios ST. LOUIS - The U.S. District Court for the Southern District of Indiana ruled on March 2 that the Escort ultra-lightweight portable liquid oxygen unit, manufactured and sold by Essex and Penox, does not violate any patent or trade dress rights held by Puritan-Bennett's parent companies. PB markets the popular Helios ultralightweight liquid oxygen unit. The presiding judge observed in his 74-page opinion that there were “stark” and “substantial”...

WASHINGTON - About 3.7 million of 4.6 million enrollees in Medicare Advantage plans, formerly known as Medicare+ Choice, will see decreased premiums and improved benefits offered by their health plan because of increases in federal payment rates, according to a review by CMS. For example, a plan in New York lowered its monthly premium to $22 - down from $140. A plan in Arizona reduced its beneficiary co-payments for certain services, including primary care physician visits, which dropped to $5 from...

The Medicare Prescription Drug Act has launched the HME provider into uncertain seas. Not since, the Balanced Budget Amendment of 1997 and the Six Point Plan of 1989 have HMEs faced such momentous change to their business. If the legislated changes are implemented, the cheese will not be exhausted, but it will be moved. The challenge? A new route to respectable profitability. Before reporting the following suite of stories, we asked HME providers for new opportunities and new ways to cut costs. Here...

Dealing with a probe review With Peggy Walker Q. What is a probe review? A. A probe (prepay) review is when a specific HCPCS code or group of codes is going to be stopped and looked at by the Medical Review team before it pays. What happens than? The claim is “developed” which means a letter is sent to the provider requesting specific information. Of course, the letter would be specific to the item being reviewed but usually includes: - A copy of the order for the item. - A delivery...

MARIETTA, Ga. - Coloplast, the leading manufacturer of breast forms in the U.S. market, and rival upstart American Breast Care (ABC) are wrangling over trade secrets, non-compete agreements and accusations of monopolization as the two companies try to settle the dust stirred up when Coloplast moved its Amoena breast form manufacturing to Germany last year. In December, an arbiter ruled that Lou Malice, the one-time president of Amoena, violated the terms of his two-year non-compete agreement by...

WASHINGTON - CMS has dug in its heels and continues to refuse industry demands that it rescind a December “coverage clarification” that restricts power wheelchairs to beneficiaries who are bed- or chair-confined. Tim Hill, Medicare's chief financial officer, called the heightened scrutiny of PWC claims and the renewed emphasis on the bed- or chair-bound criteria an effort to control skyrocketing utilization. The clarification is not, as the industry claims, a policy change requiring...