Appeals court sides with CMS contractor

From: HME News

by: Leif Kothe

PHILADELPHIA – The U.S. Court of Appeals for the Third Circuit has rebuffed a former HME provider who fought an audit and won, then filed a $10 million lawsuit against the CMS contractor that conducted the audit.

Dominic Rotella, the owner of Nichole Medical Equipment, which was improperly audited by TriCenturion and subsequently went out of business, says the outcome of the case threatens not only the HME industry, but any industry that contracts with CMS.

The End of Customer Service- Robert’s Story of The Medicare Competitive Bidding Program

From: People for Quality Care

Center for American Progress Embraces Program Facing a “Near Certainty of Failure;” Offers Ray of Reasonableness

Editor’s Note: The Center for Regulatory Effectiveness stated that HHS was likely to “vastly expand” Medcare’s competive bidding to other types of medical equipment and services as explained here.  Now major organizations, in deeply misguided if well intentioned efforts to save money, are supporting an expansion of competitive bidding.  As previous noted, The National Coalition for Health Care is supporting an expansion of the program over 240 academicians called the antithesis of science.

More recently, the Center for American Progress has released its “Senior Protection Plan” (attached here) which states that the federal government should:

National Coalition for Health Care Calls for Expanded DME Competitive Bidding, Cuts in Medicaid Payments

Editor’s Note:  The National Coalition for Health Care (NCHC) has released a fiscal plan calling for a series of tax increases and spending cuts to reduce the deficit and limit raising health care spending.  The recommendations include two proposals which would further harm the DME industry, as discussed below.  NCHC’s member organizations are listed here.  The NCHC plan, “Curbing Costs, Improving Care: The Path to an Affordable Health Care Future” is attached here.

CRE is in the process of informing NCHC that their support of competitive bidding will result in less competition and higher prices because the alleged competitive bidding program is arbitary and opposed by academic experts in competitive bidding systems.

NCPA commends Congress leaders for urging CMS to maintain diabetes delivery for independents

From: Drug Store News

By Michael Johnsen

ALEXANDRIA, Va. — The National Community Pharmacists Association on Wednesday commended seven U.S. Representatives for recently writing the U.S. Centers for Medicare & Medicaid Services to urge the agency to allow independent community pharmacists to continue same-day home delivery of diabetes test supplies to certain Medicare beneficiaries.

Under current policy scheduled to take effect July 2013, many community pharmacists would effectively be prohibited from delivering these essential medical products to patients who are homebound, or in assisted living communities. The ban on deliveries is a provision included in CMS’ competitive bidding policy for diabetes test supplies.

HME providers rally around Sandy victims

From: HME News

‘They had nothing but the clothes on their backs’

by: Leif Kothe

YARMOUTH, Maine – With the eastern seaboard reeling in the aftermath of Sandy, several HME providers have made concerted efforts to assist those devastated by the hurricane.

When William Korslin, CEO of Naperville, Ill.-based Centrad Healthcare, learned that one of his employees, Miguel Paredes, was among those adversely affected by the storm, his company undertook relief efforts.

Paredes, a distribution manager at the company’s Long Island facility, along with his family, lost their home and most of their belongings in the fire that consumed nearly 100 homes in the Breezy Point neighborhood in Queens.

CMS Issues DME Face-to-Face Encounter Final Rule, Asks for Comments

Editor’s Note:  The 1,362 page advance copy of the CMS Final Rule with comment period, “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013” is attached here.  CMS notes that they waived the proposed rule stage of the rulemaking.

With respect to DME, the rule states that it “implements provisions of the Affordable Care Act by establishing a face-to-face encounter as a condition of payment for certain durable medical equipment (DME) items.”

“I’m 83 years old and I don’t have time to run around chasing over things when you have somebody you trust, somebody you care about and cares about you, providing you with equipment.”

From: CRE’s DME Hotline: 1-800-613-7678 (Grand Rapids, MI)

This is in regards to the change in the home medical equipment law that came into effect, recently. I’m 83 years old and I don’t have time to run around chasing over things when you have somebody you trust, somebody you care about and cares about you, providing you with equipment. And, now, I’m looking at the possibility of doing business with somebody I never heard of, have no association with and if you can do anything, thank you.

Listen to complete call

Hospital audit legislation a model for HME?

From:  HomeCare Magazine

In AAHomecare’s concentrated efforts to reduce the audit burden on homecare providers, the association is carefully examining newly introduced legislation introduced on behalf of hospitals. The legislation contains a number of provisions that would help HME providers keep Medicare payments that they are entitled to for equipment and services furnished to Medicare beneficiaries.

Rep. Sam Graves (R-Mo.) recently introduced H.R. 6575, the Medicare Audit Improvement Act, a bill designed to ease the audit burden for Part A hospital claims. While the bill specifically applies to hospital claims, many of the provisions could be adapted and modified into proposals to address the audit issues plaguing DME providers. For hospital claims subject to audit, the bill would:

Do you hear what I hear?

From: HME News

by: Elizabeth Deprey

In the beginning of the Sept. 19 PMD demo congressional hearing, the two senators there thought that mobility companies that advertise on TV were pulling something over on American taxpayers. (Just watch the opening remarks and you’ll see what I mean.)

They even played commercials from both Hoveround and The Scooter Store (no idea how old or new these were, since I don’t watch a lot of TV and hadn’t seen either one before.)