In brief: Medicare audits, Anthem rate cuts, NC win

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Friday, July 10, 2020

WASHINGTON – Starting Aug. 3, auditors will restart their audit functions, according to a recently published FAQ from CMS.

If selected for review, HME providers should discuss with their contractor any COVID-19-related hardships they are experiencing that could affect audit response timeliness, states the guidance.

CMS says all reviews will be conducted in accordance with statutory and regulatory provisions, as well as related billing and coding requirements. Waivers and flexibilities in place at the time of the dates of service of any claims potentially selected for review will also be applied.

Although claims billed during the public health emergency will be subject to audits, CMS will not be enforcing the signature requirement on proof of delivery for dates of service within the PHE, which is expected to be extended past its current July 25 end date.

CMS is also reinstating prior authorizations for DMEPOS.

For power mobility devices and pressure reducing support surfaces that require prior authorization as a condition of payment, claims with an initial date of service on or after Aug. 3, 2020, must be associated with an affirmative prior authorization decision to be eligible for payment.

Anthem declines to rescind rate cuts

WASHINGTON – Anthem does not plan to rescind rate reductions of 11% to 60% for HME, AAHomecare reports.

The payer and its subsidiary, Amerigroup, implemented the cuts for its commercial and government plans in the 22 states it serves.

AAHomecare had asked Anthem to delay the cuts during the COVID-19 pandemic, making a direct appeal to President and CEO Gail Boudreaux that included the results of a supplier survey about the impact of the pandemic.

In a June 30 response, Anthem Vice President Leah Timmerman states that the cuts better align the insurer’s rates to Medicare and state and local DME market dynamics.

Anthem "took into account feedback from participating providers to help ensure we had a third-party perspective on these rate adjustments,” she said. “These rate adjustments were planned over six months ago and contractual notices alerting our DME partners of these rate adjustments were sent out well before the COVID-19 health crisis.”

AAHomecare’s payer relations team plans to provide additional analysis on how Anthem’s cuts do not reflect the current DME market and have great potential to impact patient access to quality care, especially in light of rate increases and other relief CMS and other payers have put into to place in response to the pandemic.

North Carolina rate protects DME

RALEIGH, N.C. – North Carolina Gov. Roy Cooper on July 2 signed Bill 808, including a provision creating a rate floor for durable medical equipment.

The bill, a year in the making by groups like ACMESA and AAHomecare, prohibits managed care organizations from setting rates below the state’s Medicaid fee-for-service rates for DME.

“ACMESA's strong relationship with AAHomecare enabled us to learn from the problems experienced in other states as they rolled out their MCO programs,” said Craig Rae, ACMESA president. “We were then able to act proactively to secure legislation that will protect beneficiary access to home medical equipment. Hats off to our members that took the time to contact their elected officials, and to meet with them in Raleigh to discuss the importance and impact of this legislation.”

The provision will remain in place for at least the first three years of the state’s new Medicaid managed care program, which is set to start July 1, 2021.

The provision in the bill states specifically: “For the first three years of the initial standard benefit plan prepaid health plan capitated contracts required until Article 4 of Chapter 108D of the general statues, the rate floor for durable medical equipment under managed care shall be set at 100% of the Medicaid fee-for-service rates for durable medical equipment.”

ACMESA began working on this issue in 2019 to ensure providers were fairly reimbursed once the managed care program was launched. The group worked with a lobbyist to amplify its message in the state capitol.

NSM strengthens presence in British Columbia

NASHVILLE, Tenn. – National Seating & Mobility has acquired PG Surg Med, a regional mobility provider with locations in Prince George, Kelowna, Kamloops and Vernon, British Columbia.

It’s NSM’s third acquisition in British Columbia, but its first entry into the Northern Region of the province.

“The acquisition positions NSM as the largest provider of mobility solutions in British Columbia,” the company stated in a press release.

PG Surg Med is owned and operated by brother and sister Russell and Sandy Pratt, who will remain in leadership roles at NSM following the acquisition.

In June, NSM acquired Active Mobility Products in Kelowna.

In early 2019, it first entered the Canadian market when it acquired SelfCare Home Health Products in Vancouver and Advanced Mobility Products in Burnaby.

When it bought Active Mobility Products, NSM announced plans to brand the three companies under its name.

… rebrands

NSM has officially rebranded its service offerings as NSM360: Complete Mobility Solutions to better reflect the company’s full scope of mobility, home and vehicle accessibility and service and repair solutions. “For more than 25 years we have been known as the wheelchair experts,” said Bill Mixon, NSM CEO. “However, we know mobility goes beyond the chair. NSM360 represents the full suite of solutions we provide to meet our client’s mobility needs, from simple to complex.” The company first announced the new branding at a symposium in February.

Protech: We’re ‘solid’

CINCINNATI – Demand for respiratory equipment is increasing, and demand for CPAP and other supplies remains strong, Protech Home Medical says in a July 7 corporate update. The provider says as certain U.S. states see spikes in COVID-19 cases, it has taken the necessary steps to plan, prepare and respond to a second wave. “The company’s supply chain for critical equipment remains solid and we are comfortable with our current levels of inventory,” it stated. “However, as we feel appropriate, we will opportunistically build inventory to meet the increases in demand, particularly for vents and oxygen equipment.” Protech, which recently closed on a $31.8 million offering, also says it’s focused on a corporate strategy that incorporates technology, organic growth and strategic acquisitions. “Following the closing of the recent financing, the company has cash to continue to pursue additional accretive acquisitions that are designed to build scale, within markets currently served and new markets,” it stated.

Philips Respironics launches Mask Selector

MURRYSVILLE, Pa. – Philips Respironics has officially launched its Philips Respironics Mask Selector, a 3D facial scanning solution that helps HME providers find the best mask fit for their patients. Each scan captures 150 frames and 15 million points of facial geography data. Philips’ proprietary algorithm can then identify the 46,200 data points most critical to provide an accurate and precise mask recommendation. “This data-driven solution can not only help DMEs and sleep labs operate more efficiently by reducing the burden and expense of a potentially lengthy mask fitting process, but also help to improve patient compliance by delivering a personalized mask specific to the individual needs of the patient,” Mark D’Angelo, sleep OSA business leader. In the wake of the COVID-19 pandemic, Philips is also offering a 2D version of the mask selector that can be used in the patient’s home that uses the same proprietary algorithm as the advanced 3D solution. Philips worked closely with providers to setup operations for the 2D offering at no added cost to help support their sleep business in a safe and effective way amid pandemic-driven challenges. This alternative self-scan solution simplifies the remote sizing process, sharing standard mask recommendations in moments and making them available to the DME for review, validation and fulfillment

GWCC earns certification

ATLANTA – The Georgia World Congress Center, home to Medtrade, has become the first convention center in the U.S. to earn the Global BioRisk Advisory Council’s STAR Accreditation for facility preparedness. This certifies that the facility has established cleaning protocols, disinfection techniques and work practices to minimize he risk of COVID-19 and other infection diseases. This year’s Medtrade show takes place Nov. 2-4 at the GWCC. Register here.

Oswald’s Pharmacy to offer antibody testing

NAPERVILLE, Ill. – Oswald’s Pharmacy will begin offering COVID-19 antibody testing. The 145-year-old family owned pharmacy will have phlebotomists onsite with 78 appointments available during the week; patients will receive results in 15 minutes. “These antibody tests are a great way to confirm whether or not you’ve been exposed to the virus,” said Alex Anderson, manager and sixth generation family member. “We’d like to think that once again, we’re doing all we can to keep our community educated and safe.” The pharmacy also offers home delivery, and has increased its online shopping for customer convenience and safety.

Grau moves up at MK Battery

ANAHEIM, Calif. – Wayne Grau has been named director of business development for MK Battery. Grau, who joined the company in December, has extensive industry experience, holding leadership roles in sales management, legislative affairs and trade relations. “Mr. Grau has brought a focused determination to drive more value to our customers and open up additional opportunities for our organization,” said Wayne Merdinger, president.

Sunrise launches group website

FRESNO, Calif. – Sunrise Medical has launched a new group website, www.sunrisemedical-group.com, to provide a “digital window” into the company’s presence globally. Sunrise Medical has more than 2,200 associates working in 18 countries, and distributes products in more than 130 countries. “Here we will communicate our company’s story and global reach, while highlighting our company’s passion, values, innovation and our mission to Improve People’s Lives,” Sunrise Medical stated. “Lastly, it will showcase the breadth of our products and brands in the Sunrise Medical portfolio globally.” The new group website will be accessible from all of Sunrise Medical’s local websites and vice versa, helping to provide a centralized communication platform for more timely and efficient updates and news.

People news: Dario, Quality Biomedical

New York-based DarioHealth Corp. has appointed veteran health plan executive Dennis A. Matheis to its board of directors. Matheis currently serves as president of Optima Health, a division of Sentara Healthcare, which has more than 850,000 members and a network of more than 26,000 providers. "His insights and guidance will prove invaluable as we continue our transition to a business-to-business-to-consumer (B2B2C) enterprise serving people suffering from chronic diseases through direct relationships with health plans, large employers and benefits administrators,” said Erez Raphael, Dario’s CEO. “With the addition of Dennis, I believe we now have the leadership team and Board to fully support our vision for Dario." Prior to joining Optima Health, Matheis spent 13 years at Anthem, Inc., including as president of Anthem's Central Region and Exchanges, encompassing six states and representing $12 billion in annual revenue. He previously served in senior leadership roles at Anthem Blue Cross and Blue Shield of Missouri, CIGNA Healthcare and Humana Health Plan, as well as Advocate Health Care in Chicago…Boulder, Colo.-based Quality Biomedical has named Ken Probst manager, corporate quality assurance. Probst is a Six-Sigma Black Belt certified quality expert who has spent his career in the high tech industry delivering quality management systems for services operations involving smartphones, laptops, set-top boxes and other mission-critical equipment. He has previously worked at NCR, Seagate Technology, Hewlett Packard, Teleplan and Flextronics.

Provider relief updates: PPP, Medicaid

President Trump has extended the deadline for small businesses to apply for a loan from the Paycheck Protection Program to Aug. 8. The original deadline was June 30, but as of that date, there was $130 billion still available in funding. On July 4, President Trump signed a bill that would extend the deadline to Aug. 8. “Any business that meets the qualifications for the program but has not yet applied now gets a second chance at the popular program,” VGM Government Relations stated in a bulletin…New guidance added to the Provider Relief Fund FAQs confirms that the Department of Health and Human Services is aware of a policy that penalizes Medicaid-focused providers who also serve Medicare beneficiaries, AAHomecare reports. The guidance states in the answer of one question, “Providers that are not eligible for this distribution may be eligible for future allocation of the Provider Relief Fund.” “While the new info falls short of guaranteeing measures that will provide relief for Medicaid-focused providers, the acknowledgement of the issue by HHS is a promising development,” AAHomecare states.

Rehab Medical launches app for customers

INDIANAPOLIS – Rehab Medical has launched a new customer-centric app, myRehabMedical, to provide solutions to each customer’s mobility needs. The app, available on both Apple and Android devices, provides customers with instant access to order updates, service requests, contact information, live chats and product tutorials. “Rehab Medical has a mission to improve and one way we intend to accomplish this is through innovation and the use of technology,” said Kevin Gearheart, president. “This app provides our patients with a number of tools and options that will make the patient experience second to none.” In the coming months, Rehab Medical will roll out additional features for the app, including virtual service support and mobility focused content. The app is HIPAA compliant, requiring multi-factor identification to protect customer information.

Philips ranks for innovation

CAMBRIDGE, Mass. – Royal Philips has earned a place on Boston Consulting Group’s “The Most Innovative Companies 2020,” moving up six spots to No. 23 in this year’s rankings. Philips also ranks as the most innovative medtech company. The ranking is based on a survey of 2,500 global innovation executives on global “mindshare,” industry peer review, industry disruption and three-year total shareholder return. Philips is recognized for its significant investment in research and development on everything from artificial intelligence to machine learning to virtual reality to improve health care. “Innovation has been a Philips cornerstone since our inception nearly 130 years ago and has never been more important than in today’s health care environment,” said Joseph Frassica, head of Philips Research Americas and chief medical officer for Philips North America. In addition to being included on BCG’s “The Most Innovative Companies of 2020” ranking, Philips was included in Forbes’ list of America’s Best Employers for Diversity in 2020.