In brief: Not so fast CBIC, OIG on vents, reviews expanded

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Friday, September 25, 2020

WASHINGTON – The CBIC recently sent a message indicating that Round 2021 “contract offers and disqualification information would soon be provided” in Connexion, but they did it without clearing it with CMS, according to AAHomecare. 

“Furthermore, our counsel was told that CMS has not yet made a decision on moving forward on Round 2021,” the association stated in a bulletin. 

Industry stakeholders took the CBIC’s message as a sign that maybe CMS’s next round of competitive bidding was moving forward as planned, with single payment amounts announced this summer, contract suppliers this fall and implementation on Jan. 1. 

AAHomecare and other stakeholders are awaiting details on the scope and timing for Round 2021. They have been advocating for a delay in the next round of the bid program for at least one year or through the length of the current public health emergency. 

The industry's efforts were recently boosted by a letter to CMS signed by more than 100 members of the House of Representatives requesting a delay. 

OIG: Medicare pays too much for non-invasive vents 

Agency recommends CMS include E0466 in bid program ‘as soon as possible’ 

WASHINGTON – Medicare pays more for non-invasive ventilators than certain other payers, according to a new report from the Office of Inspector General. 

The OIG estimates that Medicare and beneficiaries could have saved $86.6 million if Medicare-allowed charges were comparable with payment rates of select non-Medicare payers for HCPCS code E0466. 

Medicare paid $424.4 million for non-invasive vents in 2018, a 52% increase compared to 2016, the OIG found. 

The agency believes Medicare pays more for non-invasive vents than select non-Medicare payers because CMS does not routinely evaluate the pricing trends or payment rates of those payers. Instead, CMS uses statutorily mandated fee schedule payments and applies an economic update factor to them.  

The OIG recommends that CMS review Medicare-allowed charges for non-invasive vents and add E0466 to the competitive bidding program as soon as possible. 

In response, CMS confirmed that it has been evaluating non-invasive vents for potential inclusion in the bid program and noted that it had included the product category in Round 2021 but removed it in April due to the COVID-19 pandemic. 

The agency said it will consider whether to include non-invasive vents in future rounds of the program. 

Vertess closes four deals during pandemic 

FORTH WORTH, Texas – Vertess has closed on four DME transactions in the second and third quarters, despite the challenges brought on by the COVID-19 pandemic. 

“Even in the face of adversity that is 2020, I am thrilled to have helped deserving owners successfully exit their businesses, while also helping bridge the gap for these health care providers to extend their established platforms,” said Bradley Smith, managing director. 

The transactions are: 

Med Inc., a Virginia-based respiratory provider, has been acquired by Rotech, a Florida-based national provider. 

The assets of Metro-Med, Inc., a California-based respiratory provider, has also been acquired by Rotech. 

Health Technology Resources, an Illinois-based provider, has been acquired by Protech Home Medical Corp., a Kentucky based publicly traded health care services company. 

Alliance Medical Supply, a Texas-based pediatric respiratory and nutritional provider, has been acquired by Pediatric Home Respiratory Service, a Minnesota-based home care provider. 

CGS adds ostomy supplies, diabetic shoes to reviews 

NASHVILLE, Tenn. – CGS has announced two more widespread post-pay, service-specific reviews for ostomy supplies and therapeutic shoes/inserts. 

For ostomy supplies, the codes affected are A4431, A4434, A5081, A5122. CGS says data analysis showed Jurisdiction C’s allowed dollars for these codes were significantly above expected amounts. Additionally, these codes were consistently ranked in the top 20 for CERT errors. 

For therapeutic shoes/inserts, the codes affected are A5500 and A5512 through A5514. CGS says data analysis showed Jurisdiction B’s allowed dollars for these codes were significantly above expected amounts. Additionally, this policy group ranked No. 8 in total CERT errors. 

Medicare Advantage: CMS touts reduced premiums, increased access 

WASHINGTON – The Medicare Advantage average monthly plan premium is expected to decrease 11% to $21 in 2021, CMS has announced. 

Since 2017, the average monthly plan premium has decreased 34.2%, according to the agency, saving beneficiaries nearly $1.5 billion in costs. 

“This is the lowest that the average monthly premium for a Medicare Advantage plan has been since 2007,” CMS state. “In some states, including Alabama, Nevada, Michigan and Kentucky, beneficiaries will see average premium decreases of more than 50% since 2017.” 

Medicare Advantage continues to be popular, CMS says, with enrollment projected to increase to an all-time high of 26.9 million beneficiaries from current enrollment of 24.4 million. The projected enrollment for 2021 represents a 44% increase in Medicare Advantage enrollment since 2017. 

CMS has also announced that, for the first time, seniors who use insulin will have more than 1,600 Medicare Advantage and Part D prescription drug plans to choose from that will offer insulin at no more than a $35 monthly co-pay beginning in January. 

Additionally, benefits for 2021 include more than 94% of Medicare Advantage plans offering additional telehealth benefits reaching 20.7 million beneficiaries, up from about 58% of plans in 2020. 

Stakeholders formally ask CMS to reconsider coverage for seat elevation 

WASHINGTON – The ITEM Coalition has submitted a formal request for reconsideration of the national coverage determination for mobility assistive equipment to include coverage of power seat elevation and power standing systems for Group 3 complex rehab power wheelchairs, according to AAHomecare. The request spans more than 60 pages, references 129 clinical articles and includes a redline revision of the existing NCD for MAE, as well as a draft local coverage determination for both systems, the association says. AAHomecare was part of the work group developing the recommendations. 

NSM launches SAFE program 

NASHVILLE, Tenn. – National Seating & Mobility has launched the “Solutions for Accessible & Functional Environments” program to support home health organizations and health insurance payers in proactively preventing falls by older adults. “NSM has a proven track record of making independence and safety in and around the home a priority for our clients,” said Bill Mixon, NSM CEO. “With more than 900 experienced professionals in client homes daily and a comprehensive suite of mobility and accessibility solutions, our team has the knowledge and expertise to help increase safety to decrease falls risks.” The new SAFE program includes an integrated clinical care team to provide a turnkey solution for clients, from accessing risks in and around the home to installing needed equipment to create a more accessible and functional environment. NSM’s in-home capabilities include ramps, lifts, bathroom safety, and construction related to home and vehicle modifications. 

NCART reschedules monthly webcast 

BUFFALO, N.Y. – NCART, NRRTS, U.S. Rehab and The Clinician Task Force have rescheduled their monthly webcast to Oct. 1 at 4 p.m. ET. The webcast was originally scheduled for Sept. 24, but stakeholders didn’t want to conflict with the RESNA 2020 Virtual Conference on Sept 23 and 24. Individuals who have already registered for the Sept. 24 webcast will be automatically registered for the Oct. 1 webcast. If you haven’t registered and would like to, go here

AdaptHealth adds chief accounting officer to executive team 

PLYMOUTH MEETING, Pa. – AdaptHealth has appointed Frank Mullen as chief accounting officer, a newly created position. He will report to Jason Clemens, CFO. Mullen will manage AdaptHealth’s accounting functions, including financial reporting, controls and operations. He will also lead the development, implementation and management of enterprise-wide practices, systems and internal controls. Mullen brings more than 25 years of public company accounting and finance leadership, most recently at Ryder System, a global logistics and transportation company, where he served as vice president and controller. 

Health Mobius sees spike in online shopping 

CHICAGO – Health Mobius says its online shopping platform has helped hundreds of pharmacies and HME providers nationwide secure new revenue streams during the COVID-19 pandemic. The company estimates that its platform has delivered up to 300% increases in online sales, with some clients going from no online revenues to thousands within one month. “Small businesses and brick-and-mortar retail locations have struggled in response to changing consumer shopping habits in the wake of COVID-19,” said Kamal Haddad, CEO of Health Mobius. “As shoppers go online, small businesses need cost-effective e-commerce tools to compete with giants like Amazon and Walmart. When we looked at the clients we serve, they didn’t have easy access to an expansive virtual inventory nor the technology to compete online – so we created them.” Health Mobius offers an out-of-the-box e-commerce platform that includes website hosting, maintenance, design, branding, product pricing, payment processing, detailed reporting and customer service, and that integrates with a pharmacy’s or HME provider’s existing website. The platform’s webstore offers 40,000 products from 250 major brands. 

CIT provides financing to Protech Home Medical 

NEW YORK – CIT Group’s Healthcare Finance Group has provided a $20 million senior secured credit facility for Cincinnati-based Protech Home Medical. Protech Home will use the credit facility for general corporate purposes, acquisitions and ongoing business development, according to a press release. “With this new credit facility in place, we have added another tool in our toolbox that will further enable us to take the company through its next stage of growth with our key objectives in mind,” said Greg Crawford, chairman and CEO. In connection with the financing, CIT is also providing a package of treasury management and capital markets services. Earlier this summer, Protech Home raised about $28.8 million in a public offering. 

NCART names news officers 

EAST AMHERST, N.Y. – Chris Yule of Travis Medical is the new president of NCART. Yule has been an influential player in the complex rehab industry for more than 20 years. “I’m excited to be leading the board and staff of our CRT industry association dedicated to protecting access for people with disabilities,” he said. “Every CRT provider and manufacturer needs to be an NCART member in the interests of their businesses and of their customers. We have a lot of work to do and I look forward to joining together and meeting the challenges ahead.” Greg Packer of U.S. Rehab is vice president; Seth Johnson of Quantum Rehab is treasurer; and Alexis Ward of National Seating & Mobility is secretary. Doug Westerdahl, immediate past president, will continue to serve on NCART’s Executive Committee. “It’s been an honor to serve as NCART president for the past four years,” said Westerdahl, of Numotion. “I’m proud of the collective accomplishments we have made for the CRT community and look forward to continuing to work as a board member in pursuing our advocacy agenda.” NCART operates under the direction of a 15-member board of directors, with representatives from a cross section of small, medium and large providers and manufacturers. 

NSM expands westward 

NASHVILLE, Tenn. – National Seating & Mobility has acquired TruMobility, a complex rehab provider with locations in Las Vegas and Salt Lake City. The deal expands NSM’s presence in Nevada and Utah. “NSM continues to expand to bring our full-scope service offerings to clients in need nationwide,” said Bill Mixon, CEO of NSM. “We look forward to meeting and providing solutions to more individuals with mobility challenges in the West.” TruMobility was formerly owned by ATPs Danny Lympkin and Vernon Evans. Two of the company’s ATPs will transition to NSM. 

NHIA honors longtime champion Rep. Engel 

ALEXANDRIA, Va. - The National Home Infusion Association has awarded Rep. Eliot Engel, D-N.Y., the 2020 Congressional Leadership Lifetime Achievement Award for his longtime support and advocacy on behalf of patients in need of home infusion therapy services. “For more than two decades, Congressman Engel has worked tirelessly to expand home infusion therapy coverage for Medicare beneficiaries,” said NHIA President & CEO Connie Sullivan. “We are proud to honor him with this prestigious award in recognition of his distinguished career in promoting home infusion policies that help patients lead healthy, independent lives.” Engel has introduced several home infusion related bills, including a bill this year directing CMS to revisit its interpretation of the “home infusion calendar day” outlined in the 21st Century Cures Act. “In light of the COVID-19 pandemic, now more than ever, it is important for Congress to ensure Medicare beneficiaries maintain access to home infusion therapy services,” Engel said. “There is bipartisan support for home infusion therapy, and we know these services enable patients – especially seniors and those in vulnerable populations – to receive lifesaving care, safely in the comfort of their own homes.” 

How are you recharging employees? 

WATERLOO, Iowa – VGM & Associates has released its latest playbook, “Protecting Your Most Important Asset: Your People.” The playbook contains insight from leaders and experts within VGM and throughout the DMEPOS industry about cultivating company culture, developing strategies for growth and productivity, keeping employees engaged, investing in employees and using the unique skills of employees to best serve customers. “Within VGM & Associates, our employees are encouraged to embrace their individual skills to best serve (providers), our valuable members,” said Clint Geffert, president of VGM & Associates. “As we continue to navigate the current COVID-19 pandemic, it is more important than ever that we think seriously about human capital, what it means within each of our businesses, and how we can empower, engage and recharge our employees and co-workers to continue providing the best service and products to customers – in the midst of a pandemic and beyond.” VGM members can download the playbook at vgm.com/playbook. 

Medtrade West: There’s still time to submit presentations 

PHOENIX – Show officials have extended the deadline for presentations for Medtrade West to Oct. 9. “It’s been a crazy year to say the least,” said Mark Lind, show director. “Our presenters need a bit of extra time and that’s totally understandable. The event is seven months away, and we believe the face-to-face trade shows have more value than ever. Will things be ‘back to normal’ by then? Probably not, but we believe we can convene a safe, productive, and successful show. That all starts with presenters who want to share their expertise.” Medtrade West will take place in Phoenix April 12-14. Show officials will prioritize presentations that are interactive and in a panel format. 

Quality Biomedical opens new equipment management center 

BOULDER, Colo. – Quality Biomedical has opened its 8th respiratory equipment management center in Fresno, Calif. “We now have equipment service-management centers from border-to-border and cost-to-coast,” said Jim Worrell, chief commercial officer for Quality Biomedical. “As the industry continues to consolidate and HME companies and OEMs work to reduce the number of vendors they work with, our national network of equipment management centers helps them reduce costs and improve operational efficiency.” Quality Biomedical also has facilities in Florida, Georgia, Missouri, Pennsylvania, Indiana, Colorado and Texas. The company, founded in 2003 in Largo, Fla., specializes in servicing respiratory and infusion equipment like vents, oxygen concentrators, CPAP/BiPAP, apnea monitors, pulse oximeters and infusion pumps. It is a factory authorized service center for most of the major respiratory OEMs, including Drive/DeVilbiss, Invacare, ResMed and Breas. 

DarioHealth partners with health care management company 

NEW YORK and JUPITER, Fla. – DarioHealth has entered into a sales and distribution partnership with HMC HealthWorks, a health care management company with clinically integrated models of care that it says reduce health care costs and improve population health. Per the partnership, HMC will incorporate DarioHealth’s digital therapeutics solution into its comprehensive care management programs as both a standalone and as part of its care management solutions. “We believe this agreement with HMC is further validation of the progress we have made in transitioning to a leading provider of digital therapeutics solutions to payers, employers and other at-risk entities with a desire to help their members manage their chronic conditions and improve their clinical outcomes,” said Rick Anderson, president and general manager of North America at DarioHealth. 

Change Healthcare expands MedRx 

NASHVILLE, Tenn. – Change Healthcare has expanded MedRx to make it easier for pharmacies to provide COVID-19 testing. The platform now allows pharmacies to process and receive reimbursement for COVID-19 tests within their regular workflow. “The health care industry is undergoing a digital transformation in a time of this unprecedented crisis,” said Mark Doerr, senior vice president and general manager, Pharmacy Solutions at Change Healthcare. “We are in a position to accelerate the transformation of the health care system through the power of our platform to help drive expanded access for testing. Simplifying the billing process for our customers helps pharmacies provide a critical community service and build an important new revenue stream.” Earlier this year, the Department of Health and Human Services authorized licensed pharmacists to order and administer diagnostic tests for COVID-19. MedRx simplifies the process for both pharmacists and consumers, Change Healthcare says. When a customer requests a test, the pharmacist inputs their insurance information for payment prescreening in real time. After the test is conducted, the pharmacist simply selects the correct user code and submits the claim, secure in the knowledge that claims are billed in compliance with payer policies for the test kit and sample collection.