Archive: 2015
AAH adds muscle to audit fight
December 31, 2015Liz Beaulieu, Editor
WASHINGTON - AAHomecare plans to go live with its HME Audit Key on Jan. 15, ready to harness the power of numbers in the industry's fight against out-of-control audits.Forty-four HME companies have registered to use the tool so far, but AAHomecare believes the official launch and support from industry allies like Brightree, The VGM Group and The MED Group, and Medrade will prompt more companies to do the same.“I think we'll definitely have an uptick in participation,” said Kim Brummett,...
In brief: CMS considers MA audits, CPAP startup gets funding
December 31, 2015HME News Staff
WASHINGTON - CMS is considering expanding its RAC program for Medicare Advantage, according to a draft scope of work published by the agency.Currently, CMS audits 30 MA contracts per payment year, about 5% of the total number of contracts. Now it is considering increasing the number of contracts that are subject to some type of risk adjustment data validation audit, which validates the accuracy of diagnosis data submitted by MA organizations.“Our ultimate goal is to have all MA contracts subject...
This year's most read stories
December 31, 2015Theresa Flaherty, Managing Editor
YARMOUTH, Maine - While familiar topics once again made the list of most read stories for 2015, it's likely a bit of schadenfreude that drove one story to the top.That's because Univita, the provider at the center of the story (“'Chaos' erupts as Univita loses contracts”), didn't win many fans among providers when it gained control of the Florida Medicaid market and served as both a provider and program administrator for the majority of the managed care organizations running the program....
CMS ready to roll with prior authorizations
December 31, 2015Theresa Flaherty, Managing Editor
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.
“The fact of the matter is, the items that are going to be subject to prior auths are already under prepay review in one form or another,” said Andrea Stark, a reimbursement consultant with MiraVista. “Anything that mitigates supplier risk and financial liability is, in my book, a positive thing.”
The...
Merits joins the club
December 31, 2015Liz Beaulieu, Editor
Editor's note: Next week HME News looks at why the complex rehab market is attracting new entrants like Merits Health Products and Shoprider.CAPE CORAL, Fla. - Merits Health Products is vying for a spot in the increasingly competitive complex rehab market.The manufacturer, which makes and sells a complex rehab wheelchair for the overseas market but is best known for its consumer mobility products, plans to launch its first complex rehab wheelchair for the U.S. market in July.“The previous management...
Sutter Home Care expands footprint in California
December 30, 2015HME News Staff
FAIRFIELD, Calif. - Sutter Home Care, whose offerings include HME, respiratory therapy and home infusion, has acquired Alliance Home Health. Fairfield, Calif.-based Sutter Home Care delivers care to more than 150,000 patients in 24 counties in Northern California. Alliance Home Health offers skilled nursing, OT and PT, speech therapy, and home health aide and medical social services to patients in Monterey County. “Our partnership with Alliance Home Health will expand Sutter Care at Home's...
More MA audits on the way?
December 30, 2015HME News Staff
WASHINGTON - CMS is considering expanding its RAC program for Medicare Advantage, according to a draft scope of work published by the agency.
Currently, CMS audits 30 MA contracts per payment year, about 5% of the total number of contracts. Now it is considering increasing the number of contracts that are subject to some type of risk adjustment data validation audit, which validates the accuracy of diagnosis data submitted by MA organizations.
“Our ultimate goal is to have all MA contracts...
Z1 Auto CPAP gets upgrade
December 30, 2015HME News Staff
CHARLOTTESVILLE, Va. - Human Design Capital has released a firmware upgrade for its Z1 Auto CPAP machine and Nitelog App for Android devices. The upgrade delivers a new Z-Breathe algorithm with settings that offer more breathing comfort, improved battery life and quieter operation, according to a press release. The upgrade also allows users to sync the Nitelog App with the latest Android software version 5.1.1. The app syncs with the Z1 via Bluetooth to display sleep therapy results, including apnea/hypopnea...
Tubeless CPAP mask draws $500K in funding
December 30, 2015HME News Staff
BURLINGTON, Mass. - Startup Airing has received $500,000 in funding to commercialize its disposable, tubeless CPAP mask, according to Boston Business Journal. The funding follows a successful crowdfunding campaign in July that raised $100,000 in three hours and has netted more than $1.1 million to date by offering vouchers to buy the mask at a steep discount when (and if) it becomes available. Airing plans to retail the masks for $3. The recent funding, from a single investor, is part of a larger...
CMS publishes prior auth rule
December 29, 2015HME News Staff
BALTIMORE - CMS today issued a final rule that would establish a prior authorization process for certain durable medical equipment.
The agency, which issued a proposed rule in May 2014, had originally said a final rule would not be forthcoming until 2017.
CMS says prior authorizations will reduce overutilization of certain high cost DME without impeding beneficiary access. The agency has a “master list” of 135 codes that meet that criteria and will be potentially subject to prior...