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Tag: Sylvia Toscano


News

Stakeholders pound pavement in Florida

March 30, 2020Liz Beaulieu, Editor

TALAHASSEE, Fla. - The state of managed care in Florida motivated Sylvia Toscano, a long-time industry consultant, to visit the state capitol for the first time in January.“To see these unhealthy patterns happening with MCOs and TPAs in the state has been upsetting,” said Toscano, who was part of a group of more than a dozen members of the Florida Alliance of Home Care Services (FAHCS) to make the trip. “I'm seeing small providers just shutting down because of it. That's what got...

FAHCS, Sylvia Toscano


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News

Auditors avoid appeals process, make 'major' requests

November 27, 2019Liz Beaulieu, Editor

YARMOUTH, Maine - If you're an HME provider trying to appeal a denial by a managed care payer, it's probably not going very smoothly, reports consultant Wayne van Halem.“There's a process for appeals they have to follow that's outlined in the managed care manual and they're not doing that,” said van Halem, president of the van Halem Group.The process is similar to Medicare's: a number of levels of appeals, including redetermination, reconsideration and administrative law judge or ALJ.Instead...

Home Medical Equipment, Sylvia Toscano, Wayne van Halem


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Mobility

Notes from the field: diversification and billing

March 21, 2018Liz Beaulieu, Editor

Medicare: Take it or leave itProvider Roger Lichty has slowly transformed his business over the past few years so that vehicle mobility is now his No. 1 business.Under the product category, Mobility Connection in Rockford, Ill., offers everything from wheelchair accessible vans to vehicle lifts to driving controls. The emphasis: cash.“It's actually what's keeping us profitable at the moment,” said Lichty, owner.Mobility Connection also provides personal mobility and home access products...

Mobility Connection, Sylvia Toscano, vehicle mobility


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Mobility

DME MAC launches manual wheelchair prepay probe

December 22, 2014Tracy Orzel

INDIANAPOLIS - Few providers in Jurisdiction B seem to be affected so far by a recent prepayment review for manual wheelchair bases, including the adult tilt-in-space models, coded E1161.“We have so many audits, we can't tell one from the other,” said billing consultant Sylvia Toscano, owner of Professional Medical Administrators. “We don't have a lot of people billing E1161 in Region B since they changed it to a rental, so I don't think we're doing as many as we used to. It's...

Jackie Semrad, Kelly Wolfe, Manual Wheelchairs, Sylvia Toscano


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News

Reporter's notebook: Crash course in charting and other calamities

September 26, 2014Liz Beaulieu, Editor

For years, HME providers have been trying to teach physicians what they need to include in their chart notes, often to no avail, says Sarah Hanna, president of ECS Billing & Consulting North.But the transition to ICD-10 may be the thing that finally gets through to them, she says.“How a physician gets paid corresponds to a diagnosis procedure code,” she said. “Well guess what, to prove medical necessity for an ICD-10 code, which is more specific, you have to chart in a way that...

Kelly Wolfe, Sarah Hanna, Sylvia Toscano


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Providers

Collecting at any cost

June 13, 2014Theresa Flaherty, Managing Editor

YARMOUTH, Maine - When provider Tammy Zelenko gets ready to close the books on her fiscal year every June, she strives to close out outstanding patient balances. Sometimes, that means offering a discount to patients to get them to pay up. “You'll do whatever it takes to get that money,” said Zelenko, CEO of AdvaCare Home Services in Bridgeville, Pa. “It's better than ending up writing it off or sending them to collections.” With more patients paying out of...

Kelly Wolfe, patient collections, Sylvia Toscano, Tammy Zelenko


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Editorial

Medicare permits walker upgrades

March 28, 2014Letter to the Editor

Persistence paid off in this case. Below is the final determination from Medicare since the initial HME News article (“Unbundling trips up providers,” December 2013).The DME Medical Directors have decided that hand brakes are different from glide-type brakes and can be billed at initial issue for some walkers (i.e., E0143 is the most common HCPCS code billed) per the related Policy Article for Walkers. Use A9270 when billing hand brakes and other enhancement...

Sylvia Toscano, walkers


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News

Providers avoid shortened timeframe

December 20, 2013Liz Beaulieu, Editor

WASHINGTON - It looks like the timeframe for responding to initial documentation requests as part of the Comprehensive Error Rate Testing (CERT) program will stand at 75 days.CMS had planned to shorten the timeframe to 60 days, but Kim Brummett, senior director of regulatory affairs for AAHomecare, confirmed last week that the agency has tabled its plans indefinitely.“I received word from the CERT coordinator that the change in the timeframe has been placed on hold until further notice,”...

CERT, CMS, DME, Kim Brummett, rose schafhauser, Sylvia Toscano


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Editorial

Different take on unbundling

December 20, 2013Letter to the Editor

In response to your story “Unbundling trips up providers” (HME News, December 2013), I would like to draw your attention to the following clarification from the Jurisdiction B DME MAC:“Hand operated brakes are considered an enhancement (with the exception of those described in code HCPCS E0147). An enhancement accessory is one which does not contribute significantly to the therapeutic function of the walker. Suppliers are to bill HCPCS code A9270 when an enhancement accessory for...

Sylvia Toscano


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