Audits overwhelm pharmacists

From: HME News

ALEXANDRIA, Va. – Audits are hammering community pharmacists and that puts patient access at risk, according to a new survey.

The National Community Pharmacists Association (NCPA) asked more than 350 community pharmacists about their experiences with audits conducted by pharmacy benefit managers (PBMs) and other Medicare Part D intermediaries.

The survey found that:

• Ninety-six percent of pharmacists stated that a typical PBM contract has minimal or no transparency on how generic pricing is determined or what the reimbursement rate will be.

Industry to lawmakers: Pick up MPP

From: HME News

Cramton on bid alternative: ‘(It can) become brilliant example of government using market mechanisms in health care for benefit of society’

WASHINGTON – Industry stakeholders and CMS debated the merits of Medicare’s competitive bidding program during a congressional hearing on Capitol Hill this morning.

Industry stakeholders, like HME provider Tammy Zelenko, argued that the program hurts small businesses and urged lawmakers to replace it with the market-pricing program (MPP).

CMS: DME Bidding — It’s Not An Auction

CMS finally admitted today what DME suppliers and independent experts have long known, the agency’s bidding system for home medical equipment “is not an auction.”  The admission was made by Laurence Wilson, Director of CMS’ Chronic Care Policy Group in response to a question at a hearing by the House Small Business Committee’s Subcommittee on Healthcare and Technology, Medicare’s Durable Medical Equipment Competitive Bidding Program: How are Small Suppliers Faring?

In response, Dr. Peter Cramton of the University of Maryland who also testified at the hearing, noted that the term “competitive bidding” is synonymous with auction and that, because the law requires CMS to conduct competitive bidding, the agency is not in compliance with the law.

Senator meets with HomePlus staff

From: Home Care Magazine

ELKINS, W.V., Aug. 30, 2012– During a recent visit to Elkins, several staff members from HomePlus and Davis Health System met with U.S. Senator Joe Manchin III to discuss legislation affecting patients and companies who provide home medical equipment and services. Employees representing management, administration and clinical staff raised the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) and Medicare’s 36-month cap on oxygen equipment rental, both of which have greatly impacted reimbursement to home medical equipment providers.

House Small Business Committee Hearing on DMEPOS Competitive Bidding — September 11th @ 10:00am

From: The House Committee on Small Business/Subcommittee on Healthcare and Technology

Medicare’s Durable Medical Equipment Competitive Bidding Program: How are Small Suppliers Faring?

On Tuesday, September 11, 2012, at 10:00 A.M. the Subcommittee on Healthcare and Technology will hold a hearing titled, Medicare’s Durable Medical Equipment Competitive Bidding Program: How are Small Suppliers Faring? The hearing will be held in Room 2360 of the Rayburn House Office Building.

For years, Medicare’s benefit for durable medical equipment, prosthetics, orthotics and supplies has been plagued by a fee schedule with high error rates and above-market costs for the Medicare program, beneficiaries and taxpayers.  In response, in 2003, Congress established a competitive bidding program designed to provide greater value while ensuring beneficiary access to supplies and satisfaction with them.

Astounding utilization decreases in Round 1, says AMEPA

From: Home Care Magazine

MIAMI, Aug. 24, 2012—According to Rob Brant, board president of the Accredited Medical Equipment Providers of America (AMEPA): Medicare has finally released utilization records for Round 1 of their bidding program in home medical equipment and it did not take a Freedom of Information Act request or act of Congress to attain the records. Ironically, Medicare has included the 2011 allowable units with a corresponding list of HCPCS codes as part of the Round 1 Recompete Worksheets.

Wireless DX Monitoring: CMS –This a Company That Should Not Be Eligible for Medicare Payments!

 Wireless DX Monitoring states it provides cardiac event monitoring.  However CRE has been advised that its services are virtually worthless.  One of our  readers was provided with a unit that had a deficient battery. The battery was replaced but the unit was not providing information to the recording units. The problem—the user was not in a service area serviced  primarily by AT & T.

 A new recording device was provided with two sets of batteries both of which were to work for nearly a week. The first set of batteries died in two days as did the second set of batteries.

AAH: Delay PMD demo

From: HME News

WASHINGTON – AAHomcare on Monday called for CMS to delay a PMD demo scheduled to start Sept. 1 because the agency still hasn’t released a final version of instructions.

“AAHomecare is eager to work with CMS, but is calling for an implementation delay until 30 days after a final version of the operational guide is published on the CMS website to ensure that providers, physicians and beneficiaries have been educated on all aspects of the program,” it stated in a press release.

“We’d have to go to downtown Seattle or somewhere far away because now all of a sudden the government has put all these people out of business”

From:  CRE’s DME Hotline: 1-800-613-7678 (Kent, WA)

“Hi, this is Molly…and my husband Floyd…just got a walker, but we’re locked into one place to get it. We’d have to go to downtown Seattle or somewhere far away because now all of a sudden the government has put all these people out of business. But we’ve handled these things before and this is wrong, definitely wrong because how do you get there to get them?  It just really puts a real burden on the individual and I think this needs to be addressed, stopped. This competitive bidding is wrong.  …  Thank you, bye.”

Medical equipment providers decry Medicare effort

From: Omaha.com

By Bob Glissmann

An effort to crack down on price gouging on home medical equipment has, according to a government report, saved millions of dollars.

But the providers of such equipment as wheelchairs, walkers and oxygen concentrators say that Medicare’s competitive bidding program will create problems for U.S. businesses and consumers.

The program started in nine metropolitan areas in 2011. Next July, it’s set to go into effect in 91 other metro areas, including Omaha-Council Bluffs. It’s supposed to go nationwide in 2016.

Providers and others gathered Wednesday at Kohll’s Pharmacy and Homecare in southwest Omaha to express their concerns about the program.