In brief: OIG report, call for proposals, new videocast

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Friday, August 28, 2020

WASHINGTON – Medicare contractors were inconsistent in how they reviewed overpayments during the appeals process, says the Office of Inspector General in a new report

Although MACs and QICs generally reviewed appealed extrapolated overpayments in a manner that conforms with existing requirements, CMS did not always provide sufficient guidance and oversight to ensure that these reviews were performed in a consistent manner, the report states. 

The most significant inconsistency involved a type of testing that was associated with at least $42 million in extrapolated overpayments that were overturned in 2017 and 2018. If CMS did not intend that the contractors use this testing procedure, these extrapolations should not have been overturned; however, if CMS intended that contractors use this testing procedure, it is possible that other extrapolations should have been overturned but were not. 

The OIG recommends that CMS: provide additional guidance to contractors to ensure consistency in procedures; take steps to identify and resolve procedures used to review extrapolations during the appeals process; provide guidance regarding the organization of extrapolation-related files that must be submitted in response to a provider appeal; improve system controls to reduce the risk of contractors incorrectly marking the extrapolation flag field in the Medicare Appeals System; and update the information in the system to accurately reflect extrapolation amounts challenged as part of an appeal. 

CMS concurred with the recommendations. 

AASM makes push for student sleep health 

DARIEN, Ill. – The American Academy of Sleep Medicine will hold its first ever Student Sleep Health Week on Sept. 14-20 to encourage students to get the sleep they need to excel at school this year. 

In a recent survey by the AASM, 57% of parents with school-age children say they have a child or teen who does not get enough sleep on school nights. Nine out of 10 (94%) say lack of sleep affects their child’s mood, performance in school (93%), physical health (92%), mental health (90%) and performance in activities (90%). 

Although the ongoing COVID-19 pandemic and subsequent shift to remote learning allowed children to get more sleep than normal, it also disrupted schedules. Four out of 10 parents said remote learning affected bedtime and wake time consistency. 

“No matter where classes are held this school year — whether in-person, online or in a hybrid format — it’s important that students maintain a consistent sleep schedule to excel in both their studies and extra-curricular activities,” said AASM President Dr. Kannan Ramar. “As many parents and caregivers try to create a routine for their kids, incorporating the right amount of healthy sleep is an important component. The back-to-school transition is an ideal time for families to get back on track.” 

NCPA urges investigation of longstanding mail-order issues 

ALEXANDRIA, Va. – The National Community Pharmacists Association is urging the House Ways and Means Committee to broaden its investigation into potential delivery delays for mail-order medications due to changes at the U.S. Postal Service to include long-term problems with mail-order prescription plans. The NCPA has long said mail order has led to damaged or missing medications in some cases, expensive medication waste in others, conflicts of interest, and decreased patient choice and access to reliable pharmacy care. “Because PBMs steer customers into mail order plans this limits patients to one pharmacy, and these captive customers are essentially unable to go elsewhere, even when the patient’s medications are delayed, lost in the mail or mis-delivered,” said Karry La Violette, NCPA senior vice president of government affairs. “Problems with forced or incentivized mail order plans have been taking place for some time and too many patients have found themselves scrambling, even before added difficulties brought by the coronavirus pandemic.” The association has documented mail-order waste and abuse as part of its Waste Not, Want Not campaign. 

 NCPA opens registration for virtual convention 

ALEXANDRIA, Va. – Registration is now open for the National Community Pharmacists Association 2020 Annual Convention, held virtually Oct. 18-19. The event features education for pharmacy teams inspired by pharmacy owners, a one-stop exhibition for products and services, speakers and networking opportunities. “This will be the most convenient, most affordable NCPA Convention we’ve ever had,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA. “If you were unable to attend in previous years because of the cost, or the convenience, or the distance, or the time away from your business, this is absolutely the convention for you. It’s a can’t-miss event with no excuse to miss it.” For more information, or to register, go here. 

Medtrade West seeks proposals 

PHOENIX – Medtrade West is calling for presentations. Sessions for the event, which takes place April 12-14 at the Phoenix Convention Center, cover a wide range of topics, including legal, retail, business operations, executive leadership and planning, Medicare updates, and sales and marketing. People interested in submitting a proposal are encouraged to form a panel of three or more to present. Proposals are due Sept. 18 and may be submitted here. 

F&P launches mask setup app 

IRVINE, Calif. – Fisher & Paykel Healthcare has launched the F&P myMask, an app to guide obstructive sleep apnea patients who are new to CPAP therapy through the mask setup process. Step-by-step videos guide patients through mask fitting, fine-tuning, cleaning and assembly, offering easy access to instructions and support, and complementing the care of the health care provider. The F&P myMask app is now available in the USA on iOS and Android devices with the following masks: Evora, Vitera, Simplus, Eson 2 and Brevida. 

VMI modifies van for Health Care Hero 

AUBURN HILLS, Mich. – Chrysler and ABC’s “Jimmy Kimmel Live!” surprised Massachusetts nurse Florence Njoroge with a brand new 2020 Chrysler Pacifica that was modified for wheelchair access by Vantage Mobility International. The acknowledgement of the donation took place during Kimmel’s weekly Health Care Hero segment, which pays tribute to those on the front lines of the COVID-19 crisis. “We at VMI understand how important it is for families to have a safe and reliable vehicle that is accessible for every member of the family,” said Mark Shaughnessy, CEO of Vantage Mobility International. “Our core value is to never forget the challenges that our customers face and, to that end, we continue to partner with automakers such as Chrysler to ensure that those with mobility challenges have access to solutions that enable greater independence and make daily living activities just a little bit easier.” Njoroge’s son nominated her as a Health Care Hero, highlighting her work as a geriatric nurse at a local nursing home and rehab care facility, and as a caretaker for his father, who has been fighting ALS for the last decade. 

AAHomecare promotes ONE VOICE 

WASHINGTON – AAHomecare has launched ONE VOICE, a monthly videocast to discuss the major challenges that the HME industry is facing, and the importance of strong and united advocacy efforts to securing better policy results and rates at both the state and federal levels. The videocasts are hosted by Jeff Bowman, vice president of HME at McKesson, and one of the association’s board members. The first videocast features Dewey Roof, president of Life HME and Life H2H; James Russell, vice president and owner of URS Medical; and Tom Ryan, president and CEO of AAHomecare. 

AAH updates: Anthem, UnitedHealthcare, MACPAC 

AAHomecare has doubled down on Anthem, sharing with the payer several examples of product cuts that highlight disparities between its new rates and Medicare rates both inside and outside competitive bidding areas, as well as the average rates currently in effect under the CARES Act. Earlier this summer, the association had expressed concerns about the cuts to Anthem, and the payer responded that the cuts “better align rates to state and local DME market dynamics.” In its subsequent response, AAHomecare also noted that “the DME marketplace is not the same as six months ago when you completed your rate analysis”…UnitedHealthcare has informed AAHomecare that a system issue has been fixed and that providers should now be able to get DMEPOS claims through the Uninsured Program. Earlier this year, the Department of Health and Human Services announced a new distribution of the Provider Relief Fund to allocate funds to providers treating uninsured patients during the public health emergency. Soon after the program opened on May 6, however, providers notified AAHomecare that claims were getting rejected…The Medicaid and CHIP Payment and Access Commission, a nonpartisan agency that provides recommendations to Congress, HHS and states, has sent a letter to HHS Secretary Alex Azar asking for considerable advance notice of when the PHE will end. The commission makes the case that because Medicaid/CHIP programs operate in alliance with federal and state governments, the flexibilities allowed by CMS during the PHE can’t be just removed. 

Virginia: Stakeholders seek to restrict Medicaid MCOs  

RICHMOND, Va. – Stakeholders in Virginia are lobbying for a budget amendment that would help to safeguard DME providers by ensuring that Medicaid MCOs can’t force contract terms that are unfair or unequitable, according to ACMESA. HB5005 482.20 #59h would place a threshold on how much MCOs can discount off the Virginia Medicaid fee schedule, helping to ensure that patients have access to equipment and services, and to protect providers from additional rate reductions. Stakeholders argue the amendment, which reportedly carries a $345,000 price tag, would result in cost savings by preventing more expensive treatments in hospitals and nursing homes. They say the safeguards are needed because 50% of providers in the state have closed since 2010 and only two providers are left to serve more than 700,000 pediatric patients. “This budget amendment ensures that adults and children in all parts of Virginia will have access to ventilators, oxygen, nebulizers, beds and other HME during the pandemic and beyond,” ACMESA stated in a bulletin. “It establishes a fair and equitable playing field for both the MCOs and DME providers. Lastly, it keeps our constituents at home and protects them from the spread of the virus.” 

ACMESA names award after Tart brothers 

CARY, N.C. – The board of directors of the Atlantic Coast Medical Equipment Services Association has announced a new award, the Tart Leadership and Advocacy Award, in honor of Billy and Joey Tart, the former owners of Family Medical Supply. Billy and Joey Tart, who will receive the inaugural award at the ACMESA Winter Meeting in February, have served on ACMESA’s board for many years, each serving as president, making a name for themselves advocating “tirelessly” for the industry. “I have been with NCAMES/ACMESA since 1991 and Family Medical Supply and the Tart brothers were a constant fixture at all meetings, trips to Washington, D.C., and national trade shows,” said Beth Bowen, executive director. “They never missed an event and provided much leadership and support all my years of being involved in this amazing industry.” The Tart brothers will also receive a “Lifetime Honorary Membership” into ACMESA. The Tart brothers recently completed the sale of Family Medical Supply to AdaptHealth. 

eSolutions beefs up platform 

OVERLAND PARK, Kan. – eSolutions, a provider of health care and analytics solutions, is adding Same or Similar Batch to its eligibility platform. It will verify all HCPCS codes, including A, L and V codes, to help providers prevent denials, decrease write-offs and improve cash flow. “Our new Same or Similar Batch enhancement streamlines and automates the burdensome same or similar verification process, and it can now easily handle checking multiple patients at one time,” said Chris Hart, chief product and strategy officer. “eSolutions is committed to improving and strengthening the reimbursement cycle for DME providers so they can increase time to payment, improve cash flow and eliminate costly denials.” 

AOPA partners with Amputee Coalition 

ALEXANDRIA, Va. – The American Orthotic and Prosthetic Association has partnered with the Amputee Coalition to provide its members more resources to serve their patients. AOPA members will now be considered Amputee Coalition Partners and will be listed on the coalition’s website as such. AOPA members will also receive materials to distribute, including: inMotion magazine; First Step: A Guide to Adapting to Limb Loss; and brochures for dealing with limb loss. AOPA members will receive a packet with sample literature and a window cling. For more information, contact Betty Leppin at bleppin@aopanet.org