In brief: CMS flexibilities outlined, reimbursement relief passed up, seat elevation code released 

WASHINGTON – The U.S. Department of Health and Human Services has outlined steps that CMS has taken to assist providers to continue serving patients in the wake of the Change Healthcare cyberattack. 

Affected parties should be aware of the following flexibilities, the agencies say: 

• Medicare providers needing to change clearinghouses that they use for claims processing during these outages should contact their Medicare Administrative Contractor (MAC) to request a new electronic data interchange (EDI) enrollment for the switch. The MAC will provide instructions based on the specific request to expedite the new EDI enrollment. CMS has instructed the MACs to expedite this process and move all provider and facility requests into production and ready to bill claims quickly. CMS is strongly encouraging other payers, including state Medicaid and Children’s Health Insurance Program (CHIP) agencies and Medicaid and CHIP managed care plans, to waive or expedite solutions for this requirement. 

• CMS will issue guidance to Medicare Advantage (MA) organizations and Part D sponsors encouraging them to remove or relax prior authorization, other utilization management, and timely filing requirements during these system outages. CMS is also encouraging MA plans to offer advance funding to providers most affected by this cyberattack. 

• CMS strongly encourages Medicaid and CHIP managed care plans to adopt the same strategies of removing or relaxing prior authorization and utilization management requirements, and consider offering advance funding to providers, on behalf of Medicaid and CHIP managed care enrollees to the extent permitted by the State.  

• If Medicare providers are having trouble filing claims or other necessary notices or other submissions, they should contact their MAC for details on exceptions, waivers, or extensions, or contact CMS regarding quality reporting programs. 

• CMS has contacted all of the MACs to make sure they are prepared to accept paper claims from providers who need to file them. While we recognize that electronic billing is preferable for everyone, the MACs must accept paper submissions if a provider needs to file claims in that method. 

Additionally, hospitals may submit accelerated payment requests to their respective servicing MACs for individual consideration. HHS and CMS are working to provide additional information to the MACs about the specific items and information a provider’s request should contain. Specific information will be available from the MACs later this week. 

Package moves forward without reimbursement relief 

WASHINGTON – A narrow health care package announced over the weekend does not include provisions to extend the 75-25 blended Medicare reimbursement rate for DME in non-rural areas through 2024, AAHomecare has announced, but there’s another opportunity later this month. 

The package is part of appropriations language set for consideration on March 8, the association says. 

“While this latest development is certainly disappointing, our lobbying team remains fully engaged in working with our champions to identify other options to advance 75/25 provisions in other legislative vehicles, including another government funding package that must pass before March 22,” the association stated. 

AAHomecare asks that stakeholders continue to ask legislators to extend the 75-25 rates. The association has provided updated messaging and guidance for making the industry’s case for relief here. 

CMS releases coding, payment info for seat elevation systems 

WASHINGTON – CMS has announced coding and payment information for seat elevation systems for complex rehab power wheelchairs, AAHomecare has reported. 

The key takeaways, according to the association: 

• Discontinues existing HCPCS Level II code E2300, “Wheelchair accessory, power seat elevation system, any type,” effective March 31, 2024 

• Establishes E2298, “Complex rehabilitative power wheelchair accessory, power seat elevation system, any type,” effective April 1, 2024 

• Sets the 2024 purchase price for approximately $2,000.34. Under the capped rental rules for complex rehabilitative power wheelchairs, the rental price would be approximately $200 for months 1-3 and $150 for months 4-13 for a total of $2,100 for 13 months of continuous use. 

• Defers creation of a new HCPCS Level II code for power seat elevation equipment used with non-complex rehabilitative power wheelchairs.  

The information was included as part of CMS’s coding, benefit category and payment determinations document for the Second Biannual 2023 HCPCS Coding Cycle. See pages 135-141. 

AAHomecare says its Complex Rehab & Mobility Council will share additional analysis as applicable. 

• CMS issued preliminary recommendations for coding and pricing for power seat elevation systems in November. 

• In December, industry stakeholders made the case for making several changes, including not treating seat elevation systems as accessories. 

DOT proposes strengthening travel safety for wheelchair users 

WASHINGTON – The U.S. Department of Transportation on Feb. 28 published a notice of proposed rulemaking to strengthen its rule implementing the Air Carrier Access Act (ACAA) to ensure passengers who use wheelchair can travel safely and with dignity. The proposed rule – “Safe and Accessible Air Travel” – would require that airlines do better in accommodating passengers with disabilities by setting new standards for prompt, safe, and dignified assistance; mandating enhanced training for airline employees and contractors who physically assist passengers with disabilities and handle their wheelchairs; and outlining actions that airlines must take to protect passengers when a wheelchair is damaged during transport. “We are forging a new path for the airline industry, making air travel accessible for all,” said Vincenzo Piscopo, president & CEO of United Spinal Association in response to the news. “Now is the time for wheelchair users to share their stories, both their flightmares and their dreams of solutions for safe, accessible air travel.” The proposed rule also clarifies that damaging or delaying the return of a wheelchair is an automatic violation of the ACAA. The DOJ will accept comments on the notice for 60 days. “We must all submit comments within the next 60 days,” said Alexandra Bennewith, vice president of government relations for United Spinal. “After that, the rule can be finalized. However, we must ensure disability protections are enforced in this new rule, which is why it is so important that the Department of Transportation hear from all of us.” Comments can be filed at  www.regulations.gov, using the docket number DOT-OST-2022-0144. 

Rehab Medical opens in Miami 

INDIANAPOLIS – Rehab Medical recently opened its seventh location in Florida in Miami. "We are proud to have been able to expand our reach to the southern part of Florida,” said Jarrad Rankin, vice president of operations. “Miami has been an underserved market for some time now and with the rapid growth we’ve had, we’re now able to improve the lives of every mobility user in Florida.” Nicole Luke, an assistive technology professional (ATP) who previously served mobility users in Mobile, Ala., for nearly 12 years, will lead the office in Miami. She will have six additional staff members supporting her. Rehab Medical now offers custom advanced mobility solutions in 32 locations across 18 states nationwide. 

Doctor charged in $13.7M scheme 

SPOKANE, Wash. – Dr. Thomas Andrew Webster of Sylvania, Ohio, has pleaded guilty to conspiring to accept kickbacks in connection with a fraudulent telemarketing and medical supply scheme throughout Washington and in other states, according to the U.S. Attorney for the Eastern District of Washington. According to the plea agreement and information disclosed in court proceedings, between May 2021 and September 2023, Webster participated in a telemarketing scheme and conspiracy whereby a company identified as “Company A” obtained Medicare and TRICARE beneficiary information by using telemarketers to contact patients in Eastern Washington and elsewhere to obtain their personal and health information. Company A then used the information to create a fake medical record that falsely and fraudulently reflected doctor visits and treatment that did not exist, and fraudulent medical orders for DME. Webster then signed the fraudulent medical documentation and DME orders, which were then sold by Company A to companies that used the orders to falsely bill Medicare and TRICARE. Company A and Webster also falsely and fraudulently billed Medicare and TRICARE for the fictitious doctor visits and exams that did not take place. As a result, Medicare and TRICARE paid more than $13.7 million for DME fraudulently ordered by Webster for thousands of beneficiaries in Eastern Washington and elsewhere, including beneficiaries who lacked the limb for which defendant supposedly performed the exam and ordered the DME, because it had been previously amputated.  Webster also admitted to directly receiving at least $839,565 from Medicare and TRICARE for fraudulent doctor visits and exams that never took place.   

Florida man pleads guilty of $3.6M scheme 

TRENTON, N.J. – Steve Chicoye of Orlando, Fla., has pleaded guilty to one count of conspiracy to commit health care fraud, according to U.S. Attorney’s District of New Jersey. According to documents filed in the case and statements made in court, Chicoye and his conspirators solicited and received kickbacks and bribes in exchange for providing DME companies with completed doctors’ orders for medically unnecessary DME, such as orthotic braces. Chicoye and his conspirators utilized the service of telemedicine companies to obtain these prescriptions for DME, and the DME orders were subsequently fraudulently billed to Medicare and other health care benefit programs. Chicoye and his conspirators were paid approximately $2.1 million in kickbacks for these DME orders and caused losses to Medicare and other health care benefit programs of at least $3.6 million. 

React Health secures coding for vent 

SARASOTA, Fla. – React Health has secured a HCPCS code, E0468, exclusively for its V+C Ventilator with Integrated Cough Assist Technology (ICAT). The new code addresses the evolving needs of the medical community by providing a standardized and comprehensive system that combines two leading respiratory treatments into one device, the company says. The V+C delivers invasive, non-invasive and mouthpiece ventilation, as well as high-flow therapy and integrated cough to adult and pediatric patients weighing at least 5 kg. “React Health is committed to advancing health care solutions that contribute to improved patient outcomes and operational efficiency,” said Megan Carpenter, vice president to ventilation sales for React Health. “The introduction of E0468 aligns with our mission to empower health care providers with tools that simplify processes and overall patient care.” Features of the V+C include reducing the time to administer cough therapy with ICAT from minutes to seconds; and eliminating the need to disconnect circuits between mechanically assisted coughs, allowing the patient to remain on the vent at all times. 

VGM opens registration for Heartland 

WATERLOO, Iowa – Registration for VGM’s annual Heartland Conference, scheduled for June 10-12 in Waterloo, Iowa, is now open. Special early bird pricing is available to those who register before April 12, with registration covering all the event has to offer – education tracks, meals, entertainment, networking and more. “At VGM’s Heartland Conference, we don’t just bring together industry experts, we create a vibrant ecosystem where knowledge meets innovation,” said Lindy Tentinger, president of VGM & Associates. “From billing and reimbursement to complex rehab technology, our event covers it all. We hope you join us for two days of unlimited networking opportunities, top-notch education and a dash of Midwestern hospitality.” The event brings together industry experts from across the country to discuss topics such as billing and reimbursement, regulatory and audits, business leadership and people strategy, business operations, complex rehab technology, sales and marketing, and respiratory and specialty markets, including women’s health. Attendees can choose from more than 60 education sessions and panel discussions to earn contact hours/CEUs. New to the event this year: a Partner Connections speed-networking event to give attendees the opportunity to establish new connections, explore potential collaborations and exchange valuable insights with manufacturer and service partners. 

Dynamic Access launches brand for home infusion 

DALLAS – Dynamic Access, a provider of vascular access solutions, has launched a new affiliate brand, Dynamic Infusion, to provide home infusion nursing services for patients with chronic conditions such as autoimmune disorders, hemophilia, Crohn’s disease, rheumatoid arthritis, multiple sclerosis and more. The Dynamic Infusion brand will support the operations of two legacy companies, each with more than a decade of experience delivering home infusion nursing services to patients throughout the Northeast: Infusion Ventures in New England, and NursePro in the Mid-Atlantic. "We are excited to bring together the talent and tools from strong and experienced companies in this space," said Peter Harris, CEO of Dynamic Access and who will also serve as CEO of Dynamic Infusion. "The recent addition of NursePro expands our portfolio of specialty nursing solutions, expands our geographical footprint, and expands the number of lives we serve with life-changing care." Collectively, Dynamic Infusion will have partnerships with 35-plus specialty pharmacies and will visit patients in their homes more than 10,000 times a year across nine states. Dynamic Access partnered with RiverGlade Capital, a Chicago-based health care services-focused private equity firm, in 2021 to grow the company. 

USMCA, Medtrade partner on compression session 

DALLAS – The United States Medical Compression Alliance (USMCA) is working with Medtrade to offer additional information about the Lymphedema Treatment Act and what it means for the HME industry. The USMCA, which represents the five major manufacturers in the compression market (medi USA, Essity, Juzo, Lohmann & Rauscher and Sigvaris), will host a session at the show to provide the history and ongoing efforts to gain Medicare coverage for compression therapy garments, to detail the billing intricacies of recent changes to coverage and more. While the passage of the LTA is welcome news, Heather Ferguson, founder of the Lymphedema Advocacy Group, points out the legislation has certain limitations. “Many people assumed that the LTA would do additional things such as improve coverage for surgeries, pumps and other lymphedema-related treatment items or services,” she said. “These things were not and could not be included in the legislation, because benefit categories for those services and supplies already exist, so any modifications to coverage would need to be undertaken through regulatory action.” Speakers for the session will include Carmen Anderson, USMCA representative; Sarah M. Bramblette, MSHL, Lymphedema Advocacy Group; Bill Lobosco, SunMED Medical; and Noel Neil, ACU-Serve.