Archive: June 2004

WASHINGTON - To the frustration of many in the rehab industry, CMS continues to view a physician's progress notes as the key document when determining medical necessity during pre- and post-pay audits. “It is standard practice to review progress notes to determine medical necessity, but the doctor doesn't always document issues related to mobility, and that leaves the provider in a jam,” said Bryan Dylewski, president of Mobility Products Unlimited in Holly Hill, Fla. “If the medical...

Currently, individuals eligible for Medicare reimbursement are most often directed to power chairs as the primary mobility solution. While we agree that there is a legitimate need for power chairs, the design and function of power operated vehicles (POV)/scooters are clearly different than those of a power chair and should be recognized. POV/scooters provide numerous and significant advantages over power chairs. The small size of POV/scooters downplays individuals' limitations and enhances their...

PSA wins $500,000 Medicare audit appeal NORCROSS, Ga. - A Medicare audit appeal ruled in favor of Pediatric Services of America in May. The decision, which had been pending since November 2002, could result in a reimbursement of $500,000 of the $800,000 Medicare had recouped from the company in 2003. Medicare had said that PSA claims included incomplete clinical documentation to substantiate payment and had recouped $800,000 from PSA. The Medicare Appeals Council has until mid-July to review the...

WASHINGTON - Democratic lawmakers are suing to force the Bush Administration to release cost estimates it withheld from lawmakers during congressional consideration of the Medicare reform legislation last year. “HHS should have released these estimates during congressional consideration of the Medicare bill so that they could have informed the debate,” Rep. Henry A. Waxman, D-Calif., the ranking minority member of the House Committee on Government Reform, stated in a press release. “The...

HME providers have been slow to embrace the paperless initiative being championed by software companies, administrative specialists and financial advisors so far, but the movement may finally gain momentum with passage of the Medicare Prescription Drug Act's new reimbursement-slashing mandates. While providers may hope that Medicare reform's intent to pattern Medicare Part B after the Federal Employee Health Benefit Plan system will eliminate certificates of medical necessity and other documentation,...

WARREN, N.J. - Since the first iBot hit the streets of Riverside, Calif., in January, Johnson & Johnson has rolled out its stair-climbing, $29,000 power wheelchair in Houston, Chicago, St. Louis, New Jersey and Denver. Next up: Washington, D.C. and Miami. �  J&J declined to reveal how many iBots have been sold since the roll-out or to comment on reimbursement by third-party payers. A spokesman wrote in an e-mail that “sales are right in line with projections and everyone is pleased with...

ATLANTA, Ga. and OAK PARK Mich. - A combination of technology and homecare has created a partnership dedicated to improving outcomes for patients with chronic illness. A Nurse instructs a patient how to use a remote monitoring blood pressure cuff as part of the VNA of Southeast Michigan's telehomecare program. Atlanta-based disease management provider Heart Alert was approached in 2002 by the Visiting Nurse Association of Southeast Michigan to develop a TeleHomecare program for heart failure patients...

BRAINERD, Tenn. - The promise of heavy foot traffic and exposure lured Apria further into the world of big-box retail with the opening of two additional locations in Wal-Mart Supercenters. Apria in May opened stores in Albuquerque, N.M., and Brainerd, Tenn. Apria's initial Wal-Mart stores are found in Duncanville, Texas, near Dallas, and Phoenix, Ariz. They opened in March and April, respectively. “The retail product sales segment of healthcare is expected to grow faster than almost any other...

Getting the right John Hancocks With Maureen Hanna M. Hanna Q. What are the Medicare signature requirements for assignment of benefits? A. The Medicare Carriers Manual, section 3047.3, defines the requirements for a one-time authorization. For rental of DME the one-time authorization is limited to assigned claims only. Once the provider has obtained the authorization he may submit any later assigned Medicare claims for that equipment without obtaining an additional signature. When a beneficiary...

The best O2 system for you with Richard Glass R. Glass Q. We currently service oxygen patients with concentrators and compressed gas for portability. In the last year we have lost several patients to competitors because we don't offer liquid. How should we evaluate what type of equipment to provide going forward? A. A simple way to analyze the cost of an alternative system is to calculate the anticipated monthly operating cost savings (typically reduced oxygen and delivery costs of servicing portability...