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In brief: PHE ends, CMS audits Medicare Advantage, CQRC calls for safeguards 

In brief: PHE ends, CMS audits Medicare Advantage, CQRC calls for safeguards 

WASHINGTON – President Joe Biden has announced that the public health emergency will end on May 11, 2023. 

Under the last declaration in January, the PHE was set to end on April 11. 

“The advance notice goes beyond HHS Secretary Xavier Becerra’s previous guidance to health care stakeholders that the agency would provide at least 60 days advance notice before ending the PHE,” AAHomecare noted in a bulletin. 

Knowing when the PHE will end gives industry stakeholders a timeline for their work to maintain access to oxygen therapy and continuous glucose monitors for patients who qualified for these products under the PHE. 

Thanks to an omnibus bill that was passed in late 2022, 75/25 blended reimbursement rates in non- competitive bidding, non-rural areas will be in place through 2023 vs. the end of the PHE. 

The PHE first went into effect Jan. 31, 2020.  

CMS set to expand Medicare Advantage audits 

WASHINGTON – CMS has published a final rule in the Federal Register that codifies in regulation that, as part of the Medicare Advantage Risk Adjustment Data Validation (RADV) program, the agency will extrapolate audit findings beginning with payment year 2018. 

“Protecting Medicare is one of my highest responsibilities as secretary, and this commonsense rule is a critical accountability measure that strengthens the Medicare Advantage program,” said Xavier Becerra, secretary of the Department of Health and Human Services. “CMS has a responsibility to recover overpayments across all of its programs, and improper payments made to Medicare Advantage plans are no exception. For years, federal watchdogs and outside experts have identified the Medicare Advantage program as one of the top management and performance challenges facing HHS, and today we are taking long overdue steps to conduct audits and recoup funds. These steps will make Medicare and the Medicare Advantage program stronger.” 

Studies and audits done separately by CMS and the HHS Office of Inspector General (OIG) have shown that Medicare Advantage enrollee medical records do not always support the diagnoses reported by Medicare Advantage organizations, which leads to billions of dollars in overpayments to plans and increased costs to the Medicare program, as well as taxpayers. Despite this, CMS hasn’t collected risk adjustment overpayments from these organizations since payment year 2007. 

The RADV final rule reflects CMS’s consideration of extensive public comments and robust stakeholder engagement after the release of the notice of proposed rulemaking in 2018. 

The RADV final rule can be accessed at the Federal Register here: 

View the fact sheet on the final rule here: 

  • Read about how a recent OIG report ‘exposes’ Medicare Advantage. 

CQRC calls for safeguards to home respiratory access 

WASHINGTON – The Council for Quality Respiratory Care, is calling on the federal government to implement policies to ensure patients do not experience barriers to maintaining access to home oxygen, sleep and non-invasive ventilator therapy due to new paperwork requirements that are set to take effect when the COVID-19 public health emergency ends on May 11. 

“The public health emergency declaration went a long way towards ensuring the more than 1.5 million patients who rely on supplemental oxygen, non-invasive ventilation, and other forms of home respiratory care can access the critical, life-preserving care they need,” said Crispin Teufel, CQRC chair and CEO of Lincare. “While the end of PHE was inevitable—and the advance announcement is welcome—home respiratory patients and providers need more clarity and support to prevent potentially dangerous delays in care.”  

The CQRC is calling for a transition period with clear expectations that outline what documentation suppliers must obtain from physicians so that patients who have been prescribed home respiratory care can continue receiving these treatments.  

Specifically, the organization joins others in the home respiratory community in urging Medicare to avoid requiring patients who received home respiratory therapies during the PHE to schedule new doctor’s appointments and get a second set of tests just to create paperwork that the government suspended during the PHE.   

“If all patients need to be requalified, it will cause serious patient access issues and create enormous demand for already-overburdened physicians,” said Teufel. “There are simply not enough physicians to re-evaluate and re-test the more than 1 million patients who rely upon these therapies during the next 100 days.” 

In addition, when the PHE ends, CMS plans to implement a medical record-only review that the CQRC estimates will result in between 75% and 90% of claims being denied because they may not find the medical record does not support the physician’s decision to prescribe the therapy.   

“During the pandemic, we have learned the critical role that home respiratory therapy plays in keeping individuals out of the hospital, at home and in their communities,” said Teufel. “We welcome the opportunity to work closely with the administration and Congress to make sure that the transition from the pandemic to the new normal does not cause those who rely upon home respiratory therapies to lose access to the treatment options prescribed for them. It is important that they can continue to actively engage with their families, friends, and neighbors.” 

NCPA supports new bills 

ALEXANDRIA, Va. – The National Community Pharmacists Association supports two pieces of legislation re-introduced in the Senate that seek to bring transparency to pharmacy benefit managers. Sens. Maria Cantwell, D-Wash., and Chuck Grassley, R-Iowa, have reintroduced: 

  • The PBM Transparency Act (S. 127) would provide plan sponsors/employers transparency on how PBMs administer their pharmacy benefit and clarifies the Federal Trade Commission’s enforcement authority to prohibit unfair or deceptive business practices. It would also prohibit arbitrary claw backs of payments made to pharmacies.  
  • The Prescription Pricing for the People Act (S. 113) would keep the pressure on the FTC to complete its probe into the role and recent merger activity of PBMs, including possible anticompetitive behavior.   

“For years now, PBM tactics have led to increased costs and delayed access to care for consumers,” said Anne Cassity, senior vice president of government affairs for the NCPA. “They have also made it harder for small business pharmacies to keep their doors open. That weakens the entire health care system, because community pharmacies provide essential services to millions of Americans, especially underserved populations. For the sake of patients and independent pharmacies, reforms can’t come soon enough.”  

CMS announces PECOS redesign 

WASHINGTON – CMS has announced that submitting and tracking Medicare enrollment applications in PECOS will soon get easier and faster. Starting this summer, the agency says PECOS will feature: 

  • A single application for multiple enrollments 
  • Pre-population of data and an application that’s tailored to you 
  • Enhanced capability to add or delete group members 
  • Real-time processing checks and status updates 
  • Re-validation reminders 

The PECOS redesign will include a robust Knowledge Base with extensive content to help answer questions about enrollment, how to use all the new features and more. Watch this two-minute video or read this FAQ to learn more.  

Invacare anticipates strong sequential growth in Q4 

ELYRIA, Ohio – Invacare anticipates sequential growth in the fourth quarter of 2022, due to strong demand for its lifestyle and mobility & seating products and elevated open orders. Based on preliminary unaudited fourth quarter results, the company anticipates reporting the following results as compared to third quarter 2022: Net sales growth of 6% to $181 million as compared to $170 million, with growth in all regions and in all major product categories; gross margins, excluding the respiratory charges in 3Q22, improved substantially by 310 basis points to 26.6%; net loss and adjusted EBITDA significantly improved, driven by revenue growth, gross margin expansion due to pricing actions, favorable product mix and lower freight costs, and lower SG&A expense; and, Europe returned to profitability, confirming the 3Q22 operating loss for the segment was out of the ordinary. Invacare has filed for Chapter 11 bankruptcy protection.  

RESNA to sponsor ISS track 

ARLINGTON, Va. – RESNA will sponsor a track at the 2023 International Seating Symposium (ISS), which takes place April 13-15 at the David E. Lawrence Convention Center in Pittsburgh. RESNA is proud to collaborate with ISS to develop sessions that focus on technology convergence. This trend is affecting seating and mobility professionals, who now need to know “more than wheelchairs” to best serve their clients. Sessions include: IC03: Seat Yourself with K-12 School Teams: Collaboration is Key!, with Daniel Cochrane, MA, MS, ATP and Sheri Lenzo, PT, ATP; IC11: Standards: It’s not about where we are, it’s about where we are going!, with Patricia Karg, MSBME; and IC19: RESNA Certification Town Hall, with Julie Piriano, PT, ATP/SMS. 

Parachute Health releases annual report on e-prescribing 

PRINCETON, N.J. – Parachute Health’s e-prescribing platform is in use at more than 2,400 supplier locations supporting more than 370,000 health care providers and 54,000 clinical facilities across all 50 states, according to the company’s second annual report, “The State of DME ePrescribing.” The report provides a guide on adoption of DME e-prescribing across care settings and categories; platform data & key trends; and opportunities for clinicians, suppliers, manufacturers, health plans, hospital systems and other health care professionals in 2023 and beyond.  The report also discusses DME categories reaching e-prescribing critical mass, and shares case studies and quotes of successes from across the Parachute platform.  

ACU-Serve, Beyond HME partner on resupply 

AKRON, Ohio – ACU-Serve is partnering with Beyond HME, a Florida-based live call solutions provider, to provide resupply, and compliance and full-service consulting to its clients. "We have seen a significant decrease in resupply revenue across our customer base and needed to find a solution,” said Jim Knight, ACU-Serve CEO.” In addition, there has been a lack of support in resupply for other product categories and patient outreach." Beyond HME was founded by Jim Dragatsis, founder of AllCall Connect, which was sold to Brightree in 2017. Dragatsis served as president of Live Call for Brightree for four years before retiring at the end of 2021. He returned to the industry due to a perceived need for a higher level of service and a deterioration of true partnerships within HME resupply. "I'm ready to get back to our roots of true partnerships, the way our industry was founded before big corporations entered all facets of HME, including resupply now," said Dragatsis. "Building a customer service-driven company, founded on the principles of excellent patient care and outcomes, is the focus of Beyond. Our motto has always been that if our customers aren't successful, we aren't successful. We're ready to take Resupply to the next level and beyond."  

Aeroflow names Mica Phillips to VP of urology division 

ASHEVILLE, N.C. – Aeroflow Healthcare has promoted Mica Phillips to vice president of Aeroflow Urology, its fastest growing division. He joined Aeroflow Healthcare in 2014 as a sales representative for the company’s sleep division and his responsibilities grew by joining the urology team, where he has played a critical role in developing Aeroflow Urology as an industry leader. “I’m incredibly proud and honored to receive this new position at Aeroflow Urology,” said Phillips. “I’m looking forward to continuing to build a strong company culture and increasing operational efficiency amongst my team. I believe everyone has a right to receive sensitive medical supplies through insurance, which help restore their dignity and quality of life. I’m thrilled and extremely fortunate to lead a team that is enhancing people’s lives and promoting positive change throughout the healthcare industry.” During his tenure thus far, Phillips has provided innovative leadership and produced the company’s highest patient retention and satisfaction ratings through an emphasis on customer service. 

Hospice Source names new CIO 

DALLAS – Hospice Source, a hospice-focused durable medical equipment company founded in 1997, has promoted Tim Hines to CIO. Hines has been in the information technology and product management space for more than 25 years and has served as Hospice Source’s vice president of product and technology since June 2021, leading the successful development and deployment of the company’s new DME fulfillment system. “In addition to Tim’s strong expertise and knowledge, his heart for hospice patients and his customer-centric approach set him apart as a digital transformation leader who gets results that matter,” said Scott Snorton, CFO of Hospice Source. Prior to joining Hospice Source, Hines held leadership roles at FedEx, IntelliCentrics, Kalkomey Enterprises and more. He holds a Bachelor of Science and a Master of Science in Information Technology.  

VGM names retail director 

WATERLOO, Iowa – Tim VanAntwerp, formerly of Van’s Medical Equipment, has joined VGM & Associates as director of retail services. He’s tasked with assisting VGM members with meeting their revenue goals through retail sales. “At VGM, we strive to help our members thrive in the DMEPOS industry, and Tim will be a major asset to our members looking to explore the retail side of the business,” said Mike Isaacson, senior vice president of operations for VGM & Associates. “Additional product lines supporting DMEPOS but not traditionally reimbursed is a great additional source of revenue for providers, and we are thrilled that Tim will be able to share his expertise with our VGM members.” VanAntwerp, who has experience inside and outside of hospital systems and who has been a strong advocate for the HME industry throughout his career, will assist VGM’s 3,000 providers who have nearly 7,000 locations. He was a VGM member himself. “I am excited to assist members with their retail sales to meet their revenue goals and their customer needs,” said VanAntwerp, who was 13 when he started working in his father’s pharmacy. “Through education, training and company policies, I believe any DMEPOS provider can achieve patient direct sales equal to or greater than any other payer’s slice of the pie.”  

U.S. Rehab partners with Nymbl 

WATERLOO, Iowa – U.S. Rehab, a division of VGM & Associates, has announced a partnership with Nymbl Systems, a multipurpose, 100% cloud-based practice management software. “U.S. Rehab has worked closely with Nymbl Systems over the last several months to build out the most intuitive, accurate and error-proof billing software in the complex rehab technology marketplace and we couldn’t be more excited about bringing this solution to our members across the U.S.,” said Tyler Mahncke, vice president of U.S. Rehab. “Our goal was really to put a billing management system together that allows our provider partners to spend less time on the complicated billing process and more time with their patients, which will ultimately lead to better profitability and less stress. We are confident that Nymbl’s software, their leadership team and great customer service will be well received in the CRT community.” U.S. Rehab’s members encompass more than 1,300 independently owned locations providing quality custom or complex rehab equipment. Nymbl will work with U.S. Rehab and its members to further develop the software. “The industry experience they bring to the table is something we are excited to learn from and more importantly, use to create functionality in our software to help their members become more efficient and more profitable,” said Chad Feinberg, COO of Nymbl. 

Merits promotes Grau to director 

FORT MYERS, Fla. – Merits Health Products has promoted Kirk Grau to director of national sales. Grau joined the company in 2017 and has led the Western Region for five years. “Kirk has been instrumental in building a team and advancing our sales initiatives and strategies,” said Bret Tracy, vice president of sales. “Kirk is an industry veteran of 23 years with a proven record of sales achievements.” Grau, who has a Bachelor of Science degree from Texas Tech university, is also a captain with the Double Oak Volunteer Fire Department.  

NCART adds members 

WASHINGTON – NCART has announced that it has two more manufacturer members: Nymbl Systems and Tolt Technologies. Nymbl is a 100% cloud-based electronic medical records and practice management system. It launched in 2018. Tolt Technologies makes drive control options that allow individuals to maneuver power wheelchairs using eye-gaze technology. It launched in 2020. “We couldn’t be prouder to be working alongside each and every one of our member companies to protect access to CRT and want to continue to expand our advocacy reach,” NCART stated. “The financial support of dedicated CRT providers and manufacturers is the foundation that enables NCART to carry out our important advocacy work.” Learn more about becoming a member here.  


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