Discussion Forum

From: Home Care Magazine

Medicare requires layers of documentation

by Sarah Hanna

For many providers, oxygen is the lifeblood of their revenue cycle. But Medicare is making it increasingly difficult to keep the oxygen cash flow in a positive state.

We have CERT, pre-pay audits, Additional Documentation Requests (ADRs) and also more complicated redeterminations and reconsiderations to validate a patient’s medical need. 

Remember the good old days when a Certificate of Medical Necessity (CMN) sufficed as proof of medical necessity? Unfortunately, our new reality involves chart note documentation from referral sources.

From: Home Care Magazine

An online petition against competitive bidding gained traction last week ahead of AAHomecare’s Washington Legislative Conference Feb. 15 and 16. The petition, which was the brainchild of an HME provider’s daughter, quickly attracted 1,500 signatures and support from 15 state and regional HME associations.

It originated with Peter Falkson and Eric Cohen of National Sleep Therapies, members of the New England Medical Equipment Dealers Association (NEMED), and started with a conversation Falkson had at home about competitive bidding.

“I was talking to my wife about competitive bidding telling her how it was so poorly aligned,” Falkson told the … Continue Reading

Current Bid System Replaces Cost-Effective Home Medical Equipment with ER Visits and Hospitalizations

WASHINGTON, Feb. 16, 2012 /PRNewswire-USNewswire/ — Citing the likelihood that Medicare beneficiaries are not receiving necessary medical equipment and services, the American Association for Homecare is urging Congress to adopt the Market Pricing Program (MPP) to replace the controversial bidding program for home medical equipment and services, or durable medical equipment (DME).

Data from the Centers for Medicare and Medicaid Services (CMS), which implemented the bidding program in nine test areas a year ago, shows that reimbursement claims for home medical equipment fell in those … Continue Reading

WASHINGTON, Feb. 14, 2012 /PRNewswire-USNewswire/ — The Center for Regulatory Effectiveness reports that the President’s Budget proposes to slash reimbursement to state Medicaid programs for beneficiaries who use home oxygen and other Durable Medical Equipment.  The proposed budget would cripple the ability of Medicaid beneficiaries to remain in their homes. Instead of protecting the viability of home medical care as a cost-saving alternative to more frequent hospital admittances and prolonged nursing facility care, the Budget proposes to extend a discredited payment system which is already reducing … Continue Reading

Editor’s Note:  The WSJ’s analysis and conclusions regarding CMS’ fatally-flawed competitive bidding progam with respect to negative pressure wound therapy also apply to the other home medical equipment and related services procured under the program.

From: Wall Street Journal

How Medicare rigs competitive bidding and hurts patients.

Americans may not be familiar with the medical innovation called negative pressure wound therapy, though it has helped hundreds of thousands of patients with complex or chronic injuries like burns or diabetic ulcer complications that could never heal on their own. Now President Obama’s Medicare team is about to severely damage this field, and many … Continue Reading

From: HME News

Economic impact study finds that for every $1 generated by The Diabetic Shoppe, it adds 27 cents to local economy

By Theresa Flaherty, Managing Editor

Through a combination of luck and persistence, provider Robert Salmon has “grown a nice” diabetes supply business in rural Tallahatchie County, Mississippi. 
But it’s more than just a nice business for himself and his employees, he’s learned. It turns out that his company, The Diabetic Shoppe, has a large impact on the local economy, according to a recent economic impact study by Mississippi State University graduate students. The study found that for every dollar … Continue Reading