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In brief: Regulatory update, e-prescribing report, Lincare acquisition

In brief: Regulatory update, e-prescribing report, Lincare acquisition

WASHINGTON – CMS on Feb. 10 published a change request notifying the DME Medicare Administrative Contractors of the agency’s new national coverage determination for home oxygen therapy. 

CMS notes the following changes are effective for claims with dates of service starting Sept. 27, 2021: 

expansion of oxygen coverage for acute and chronic conditions; 

expansion of coverage for short and long-term need (when hypoxemia exhibited); 

the ability of the MACs to determine if oxygen and equipment are reasonable and necessary; 

and the ability of the MACs to make coverage determinations for patients with cluster headaches. 

“This is the first guidance CMS has published publicly to the DME MACs regarding the updated oxygen NCD,” AAHomecare stated. 

Limits set for RAC reviews 

The Recovery Audit Contractor (RAC) starting April 1 will limit additional documentation requests (ADRs) based on the number of paid Medicare claims a provider has in a given product category, AAHomecare reports. 

Currently, the RAC bases reviews on the total claim number by NPI, without consideration for the number of claims in a category, resulting in the possibility of a provider receiving large volumes of audits for categories in which they do minimal business. 

“This new change will allow the RAC to account for volume of claims by product category, which should improve the RAC’s program integrity efforts,” AAHomecare stated. 

The new guidance states: “Limits will be set at 105 of all paid claims, by policy group, paid within a previous 12-month period, divided into eight periods (45 days). Although a RAC may go more than 45 days between record requests, in no case shall a RAC make requests more frequently than every 45 days.” 

Parachute Health releases e-prescribing report 

PRINCETON, N.J. - Parachute Health has released a new report on the rapid adoption of DME e-prescribing, data trends and opportunities for health plans, clinicians, DME suppliers and other health care professionals in 2022 and beyond. 

The report, “The State of DME ePrescribing,” acknowledges the value of DME e-prescribing and similar technology solutions in the context of COVID-19, which has stretched health care systems to their limit, expanded reliance on home care and underscored the need for overwhelmed providers to focus on patient care over paperwork, the company says. 

“In 2022 and beyond, Parachute Health will continue to focus on removing friction from the ordering experience to empower providers, power supplier growth and held order conversion, and increase transparency and efficiency for payers and health plans of all kinds,” the company says. 

Parachute based the report on platform use by more than 2,000 supplier locations supporting more than 100,000 physicians and 40,000 clinical facilities across all 50 states. 

Former Arriva consultant settles allegations 

STUART, Fla. – Ted Albin, a reimbursement consultant who provided services to Arriva Medical, and his firm, Grapevine Billing and Consulting Services, have agreed to pay $50,000 to resolve allegations they violated the False Claims Act. 

In an emailed statement to HME News, an attorney representing Albin and Grapevine said the case was without merit. 

"Mr. Albin and Grapevine did nothing wrong, and they should never have been part of the government’s lawsuit in the first place. To put this matter behind them, they have entered into a settlement for $50,000 – a small fraction of what it would have cost to clear their names at trial. After nearly three years of litigation concerning allegations from more than a decade ago, Mr. Albin and Grapevine are pleased to be moving on." 

In its complaint, the United States alleged that, from 2008 until 2017, Albin and Grapevine provided consulting services to now-defunct Arriva, its parent Alere Inc., and Abbott Laboratories ((after Abbott acquired Arriva and Alere in October 2017)). From at least 2009 until 2011, Albin, through Grapevine, allegedly served effectively as the head of reimbursement at Arriva, overseeing Arriva’s reimbursement department, developing Arriva’s policies for the collection of beneficiary copayment obligations and submitting claims to Medicare on Arriva’s behalf for diabetes testing supplies. 

“Consultants must abide by federal requirements when providing Medicare billing advice,” said Brian M. Boynton, acting assistant attorney general for the Justice Department’s Civil Division. “We will continue to protect the integrity of federal health insurance programs by pursuing individuals or entities responsible for the submission of false or fraudulent claims, including those who cause such claims to be submitted.” 

Arriva ceased operations in December 2017 after an appeal seeking to reinstate its Medicare billing privileges failed. CMS revoked those privileges in 2016, alleging the provider submitted 211 claims for deceased patients between April 15, 2016, and April 25, 2016. 

Prior to that, Arriva had been the top provider of mail-order diabetes supplies, receiving nearly $120 million in Medicare payments in 2015. 

Arriva and Alere, a Waltham, Mass.-based medical device manufacturer, were acquired by Abbott Laboratories in 2017

Mendo-Lake Home Respiratory Services sells to Lincare 

LAKEPORT, Calif. – Mendo-Lake Home Respiratory Services, “your local home oxygen specialists,” has sold to Lincare, Paragon Ventures has announced. 

Rob Gambill and Rick Gonzales founded the company, which employs respiratory therapists, equipment technicians and support staff, in 2006. 

“It was a pleasure to work both with Rob and Rick, who share a common mission and drive for excellence and service,” said Samantha Lincoln, a managing director at Paragon Ventures, which served as the exclusive merger and acquisition advisor to Mendo-Lake. 

Terms of the deal were not disclosed. 

Mendo-Lake is a provider focused on respiratory therapy and DME serving Lake, Mendocino and northern Napa counties. 

Philips makes Top 500 list  

CAMBRIDGE, Mass. - Royal Philips has once again landed on the Forbes “America’s Best Employers of 2022” list. Philips ranked 330 on the list. “At Philips, our purpose is to improve 2.5 billion lives a year by 2030, including 400 million in underserved communities,” said Richard Kranz, head of human resources at Philips North America. “This can only be accomplished with a team of dedicated professionals who share a passion to put our healthcare partners and patients first. Recognition as one of America’s Best Employers reflects our culture of promoting personal development, inclusion and diversity and validation of the environment we have created where each person can be their best and help improve people’s health and well-being through meaningful innovation.” Forbes and Statista selected “America’s Best Employers 2022” through an independent survey applied to a vast sample of approximately 60,000 employees in America working for companies with more than 1,000 employees in the country.  

Ascensia participates in Spare a Rose campaign 

BASEL, Switzerland – Ascensia Diabetes Care is supporting the Spare a Rose campaign, which encourages people to donate the money they would otherwise spend on a rose on Valentine’s Day to charity, for the fifth consecutive year. Ascensia is encouraging its 1,500 employees to donate to Spare a Rose and has committed to matching their donations up to one rose, or $5, per employee, plus an initial $5,000 donation. “The Spare a Rose campaign was created by the diabetes community, for the diabetes community, and we are incredibly proud to support it for the fifth year in a row,” said Robert Schumm, president, Ascensia. “It’s hugely important for us to support the global diabetes community and actively live our value ‘Only Diabetes’. I am always impressed with the generosity and enthusiasm of our employees that surrounds this initiative.” Ascensia and its employees are one of the largest fundraisers for this campaign to date, having raised more than $56,000 over the past few years. This year’s beneficiary will be Insulin for Life, which provides insulin, supplies, education and advocacy to help save the lives of people with diabetes in disadvantaged regions.  

Vertess hire financial analyst 

FORT WORTH, Texas – Kim Harrison has joined VERTESS as financial analyst. Harrison, who got her start as an auditor at Ernst & Young, was previously a CFO in the behavioral health industry, controller for a toxicology lab and staff accountant in a professional organization for dentists. “I started my career as an auditor for Ernst & Young, working primarily with venture capital firms, and I have also held roles in the vending, hospitality and advertising industries,” she said. “I have been a key player in the M&A process from the seller and buyer side, and thus understand the operational needs and challenges of a company in an M&A phase of their life cycle.” A licensed CPA, Harrison holds an MPA from the University of Texas. 

Quipt reports increase for Q1 

CINCINNATI – Quipt Home Medical Corp. reported revenue for its fiscal first quarter of $29.5 million for its fiscal first quarter 2022, which ended Dec. 31, 2021, an increase of 30% over the same quarter one year ago. Adjusted EBITDA for Q1 2022 was $6 million, compared to Adjusted EBITDA for Q1 2021 of $5.2 million, an 16% increase of year-over-year. Cash flow from continuing operations was $5.3 million in Q1 2022 compared to $2.8 million in Q1 2021, an increase of 90%. “The continued momentum across the business shown through our record first quarter results exemplifies our ability to successfully navigate our operations through a challenging supply chain environment driving consistent business performance,” said Greg Crawford, chairman and CEO. “Demand continues to remain at robust levels surpassing historical run-rates for respiratory equipment and services, evidenced by strength in our oxygen and ventilation therapy service lines. Inclusive of the sleep device supply constraints we remain on track for our calendar end 2022 financial outlook and anticipate a further lift as the sleep device patient backlog subsides in the second half of the year.” Earlier this month, Quipt posted a record-breaking year for its fiscal 2021 with $102.4 million in revenues, a 41% increase compared to $72.6 million for fiscal year 2020.   

NHIF honors Melissa Leone 

ALEXANDRIA, Va. – The  National Home Infusion Foundation has named Melissa Leone, RN, BSN, as the recipient of the 2022 Lynn Giglione Women in Leadership Award. Leone currently serves as the Executive Director of Nursing Operations at Coram CVS Specialty Infusion Services. She started working in home infusion in 1990 and through various acquisitions and changes, has been in the business for more than three decades. “I am honored to have been selected for this recognition,” said Leone. “I admired Lynn for many years as she expanded her contributions and leadership within NHIF and it is an incredible feeling to be recognized in her memory. I have enjoyed the opportunity I have had to bring greater attention to the benefits home infusion offers to people seeking alternative care settings and influence change in the health care arena.” The Lynn Giglione Women in Leadership Award, established in 2015, recognizes and honors trail-blazing and emerging women leaders who have demonstrated exemplary service to patients and their peers while promoting the mission of NHIF. Leone has been an integral member of NHIA’s Education Committee for more than 20 years helping to generate highly specialized home infusion clinical and nursing content and building out the RN Essentials programming. Leone is also a regular contributor to INFUSION magazine where she has been a leader in sharing practice-related data and clinical practice guidelines. Last year, she was recognized as an NHIA Fellow.  

Follow-up survey seeks additional PHE-related costs 

WATERLOO, Iowa – VGM is asking providers to participate in a follow-up survey related to the real cost of providing equipment, such as oxygen, hospital beds, mobility equipment, and more to patients’ homes before and during the public health emergency. A previous survey of nearly 100 independent providers was shared with elected officials and other industry stakeholders. Those same elected officials and stakeholders recently requested that VGM follow-up with questions relative to certain other PHE affiliated burdens which might affect appropriate patient service. The questions are limited and should take only a few minutes to complete. Please consider a reply; your input is critical to these officials and decision-makers.  

Power mobility guideline for infants and toddlers introduced 

STOCKHOLM – The first guideline on introducing powered mobility to infants and toddlers has been released. “A Guideline for Introducing Powered Mobility to Infants and Toddlers,” is an interdisciplinary guideline based on peer-reviewed literature and validated consensus statements from over 40 international clinicians and caregivers that provides critical strategies and practical tips for clinicians working with powered mobility. Permobil is a supporter of the guideline. “Despite there being a consensus among subject matter experts on the importance of access to powered mobility for infants and toddlers, there is no Standard of Care that healthcare professionals can lean on. This Guideline looks to address that absence,” said Karin Leire, VP Research & Innovation at Permobil. The Guideline was first presented at the International Seating Symposium on Feb. 1. It is available here

Providers meet with gov’t officials 

WATERLOO, Iowa – HME providers in Kentucky and Tennessee attended a virtual meeting with various government officials to discuss the tornadoes that ripped through those two states in December. The meeting, which was assembled by Tangita Daramola, the competitive acquisition ombudsman, and the VGM Government Relations team, was attended by representatives from FEMA, the Office of the Assistant Secretary with Preparedness and Response, the Small Business Administration, CGS and CMS’s Office of Program Operations and Local Engagement. “Much of the discussion included billing and reimbursement concerns during and after a disaster, as well as additional expenses incurred by suppliers,” VGM stated. “This meeting was a great steppingstone for an end goal of improved processes and clear guidance and policies for DME suppliers during an emergency.” Also attending the meeting were members of the Emergency Preparedness for Home Medical Equipment Suppliers Committee, which includes state association leaders, AAHomecare’s Kim Brummett, and VGM’s John Gallagher and Emily Harken. “The (committee) is looking forward to continuing to educate the federal groups on all the distresses and invaluable services DME suppliers provide during and after a disaster,” VGM stated. “The group’s intent is to make solid changes for suppliers in future disasters and broaden awareness with federal groups.” 

Sunrise Medical taps Pedersen to lead education 

FRESNO, Calif. – Sunrise Medical has appointed Jessica Presperin Pedersen, who has more than 40 years of clinical practice as an occupational therapist, as director of clinical education for North America. Pedersen has worked in all sectors of the wheelchair and seating industry as a master clinician, supplier, manufacturing consultant, design representative and educator. “The further development of our clinical education team is a critical part in our success and Jessica brings an unparalleled amount of clinical experience and industry knowledge,” said Larry Jackson, president of Sunrise Medical Americas. “Beyond clinical education, we fully expect Jessica to contribute to the development of exciting new products that exceed our customers’ expectations and create better clinical outcomes. She provides us with so many opportunities to both further our products and collaborate with others to create supporting research that proves their value to payers.” Pedersen, who is a RESNA and AOTA Fellow and who serves on the Clinician Task Force and AOTA’s Seating and Wheeled Mobility Committee, has a long list of accomplishments, including founding the first wheelchair clinic in Chicago at the Rehabilitation Institute of Chicago and becoming one of the first professionals to be certified as an assistive technology professional. 

Senseonics gets next-gen approval 

GERMANTOWN, Md. – Senseonics has announced approval by the U.S. Food and Drug Administration for its next-generation Eversense E3 CGM System. The Eversense E3, which includes proprietary sacrificial boronic acid technology to extend longevity to six months, is planned to be available in the U.S. through Ascensia Diabetes Care, the company’s global commercial partner, beginning in the second quarter of 2022. “We repeatedly hear from our patients with diabetes that what they desire is a long-lasting sensor that is also highly accurate,” said Satish Garg, M.D., professor of medicine and director of the Adult Diabetes Program at the Barbara Davis Center of the University of Colorado, and the principal investigator of the PROMISE Study1, which formed the basis for the FDA approval. “The next generation Eversense E3 System delivers on both. This is another step forward for patients who desire to manage their diabetes with all the advantages of the Eversense CGM with the fully implantable sensor.” With approval for the Eversence E3, Senseonics is now providing a financial outlook for 2022, including global net revenue of $14 million to $18 million. 

InfuSystem adapts to ‘rapidly changing conditions’ 

ROCHESTER HILLS, Mich. – InfuSystem reported net revenues of $26.5 million for the fourth quarter ended Dec. 31, 2021, a 7.3% increase compared to the same period the prior year. Net income was $400,000. The company reported net revenues of $102.4 million for the full year, a 5.1% increase compared to the prior year. Net income was $1.4 million. “InfuSystem delivered record revenue in 2021, with revenue surpassing the $100 million mark for the first time, coming in at $102.4 million,” said CEO Richard Dilorio. “We achieved this important milestone while operating through another challenging period as the Omicron variant broadly impacted the American healthcare sector during the 2021 fourth quarter. The entire InfuSystem team did a great job of not only adapting to rapidly changing conditions, but once again maintaining industry-leading service levels for patients and providers during this difficult period.” InfuSystem reported gross margin for its DME segment was $4.3 million for the fourth quarter, representing a decrease of $400,000, or 9%, compared to the same prior year period. This decrease was due to a lower gross margin offset partially by an increase in net revenues. InfuSystem said it cannot properly forecast new revenue for fiscal year 2022 because of business start deferrals related to both Omicron and extended contracting processes. However, based on current expectations, it currently estimates approximately 20% overall revenue growth with equal top-line contributions coming from the ITS and DME segments. It expects a large new biomedical contract* to contribute much of the growth in DME, which may vary depending on the timing of when the parties finalize the contract. 

Great Elm improves DME 

WALTHAM, Mass. – Great Elm Group reported total revenue for its DME division grew to $15.7 million in the second quarter of fiscal year 2022, an 8.1% increase compared to the same period in the prior year. Net income was $900,000 vs. a net loss of $2.9 million. “The increase in revenue was due to organic growth in resupply sales, a significant reduction in bad debt expense and the impact of previously announced acquisitions,” the company stated. Great Elm Group reported adjusted EBITDA of $2.6 million vs. $1.9 million. Most recently, Great Elm acquired the power mobility assets of MedOne Healthcare. 

Precision Comfort adds BodiTrak 

CAPE CORAL, Fla. – Precision Comfort, a division of Merits Health Products, has added BodiTrak pressure-mapping technology to its product line. The company says BodiTrak is well known for its user-friendly SmartFabric sensor technology that provides instant and accurate pressure-mapping assessments. “This powerful data collection helps identify user requirements for standard or customized surface and positioning solutions,” the company said in a press release. “ATPs and clinicians can show end users how their body works with the different positioning systems – this tool is a great way to guide them in the process of wheelchair cushion selection and how to accomplish pressure reduction.” The company says strategies to prevent pressure injuries may cost substantially less than treatment, according to clinical studies – it’s estimated that treatments can cost as much as 2.5 times the cost of prevention. Precision Comfort is carrying both the BodiTrak Lite and Pro versions. 

VERTESS adds health care IT expert 

FORT WORTH, Texas – VERTESS has a new managing director and partner: Anna Elliott, who specializes in high-growth health care technologies like deep tech, artificial intelligence, machine learning and ambient solutions. Previously, she co-founded the boutique merger and acquisition advisory firm M&A Finders based in Pittsburgh. “Although I experienced enormous success with M&A Finders, I realized I could help my clients even further with a deep bench of support,” she said. “It is energizing to be working alongside this group of motivated, productive and encouraging people who are committed to excellence.” Elliott is skilled at “microtargeting” needs and opportunities throughout the supply and demand process for businesses, VERTESS says. Over the past 15 years, she has helped to add $150 million in value to various organizations. “We have known Anna for several years and were always impressed by her accomplishments and loyalty to her clients,” said Brad Smith, managing director and partner. “We consider it a huge win for our team and our clients to have her join us. Anna’s experience and achievements in the health care IT sector are phenomenal.”


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