Issue link: http://read.dmtmag.com/i/59015
■ Expect to see consolidation in the diabetes market, says analyst Jonathan Sadock. See story page 1. CMS releases list of off-the-shelf orthotics ........... 29 UroMed partners with publilsher on CEU program ..... 29 Q&A: Bruce Roberts .............................. 30 KCI restructures ................................. 31 Rx and Specialty Providers WWW.HMENEWS.COM / APRIL 2012 / HME NEWS 29 BRIEFS Two diabetes providers settle No-Call allegations JACKSON, Miss. – Direct Diabetic Source and Med-Care Diabetic & Medical Supplies in February settled allegations that they had violated the state's No-Call Law. According to local news reports, the Mississippi Public Service alleged that the providers did not register as telephone solicitors, did not buy the Mississippi No-Call List and called con- sumers listed on the No-Call List. The pro- viders paid $5,000 each to settle the claims. Smith & Nephew passes the billion-dollar mark ST. PETERSBURG, Fla. – Smith & Nephew's advanced wound management division exceeded $1 billion in revenues in 2011, a company first, it said in a statement. Full year revenue for 2010 was $912 million. For the fourth quarter, which ended Dec. 31, 2011, the division posted revenues of $271 million, an 8% increase over the same period in 2010. The company launched 35 new products in 2011 and expects to maintain a similar level in 2012, it stated. Catheter claims flunk paperwork requirements WASHINGTON – Nearly 85% of claims for intermittent sterile catheter kits (A4353) were denied during the fourth quarter of 2011, according to a targeted review by National Government Services, the Juris- diction B DME MAC. The DME MAC re- viewed 635 claims for medical necessity. The review found 84.3% of claims denied: 48% because documentation did not sup- port the level of service and 34% because no documentation was returned. Suppli- ers can review documentation guidelines in the urological supplies local coverage determination (L27219) and policy article (A47236). Shield Healthcare creates new award VALENCIA, Calif. – Shield HealthCare in March announced the recipients of its first annual Reader's Choice Award win- ners. The mail order provider created the Reader's Choice Award after it received a record 580 entries as part of its 11th annual "What Makes Caregiving Reward- ing?" contest. Shield selected eight win- ners, and then invited the public to vote for their favorite caregiver stories. The Reader's Choice winners are: Carol L. of Topeka, Kan., caregiver for her mother with dementia; Shelley H. of Robinson, Texas, nurse and caregiver for her two disabled children; and Debra B. of Enid, Okla., professional caregiver. Short take Provider Lisa Feierstein in February was named a 2012 Top Entrepreneuer by Busi- ness Leader magazine. Feierstein is the co-founder of Raleigh, N.C.-based Inte- graSleep and Active Healthcare. Each year, Business Leader recognizes top en- trepreneurs in the South. Auditor overreaches with CPAP claims 'Do they think most of these patients didn't get a study?' BY THERESA FLAHERTY, Managing Editor gy for HME providers—and auditors, say industry sources. Connolly Healthcare, a recovery audi- A tor contractor (RAC), has been asking for proof that patients have had a qualified sleep study in cases where Medicare did not pay for the study. That's basically any patient whose study was paid for by a pri- vate insurer or who paid out-of-pocket— not uncommon for a condition that is often diagnosed before patients reach Medicare age. "It's very far-reaching," said Andrea Stark, a reimbursement consultant with MiraVista in Columbia, S.C. "It's a lot of work to be able to pull all these patients, get the sleep studies that may be very old and produce that information." Particularly vexing: There's no proof that there is even a problem, she says. "Do they really think that most of these patients didn't get a study—that providers SEMI-AUTOMATED REVIEW of cer- tain CPAP claims in Jurisdiction C could be a waste of time and ener- are just randomly billing?" Stark said. Some providers have been lucky enough to receive only one or two requests like this. "If we get an order for supplies or device replacement, we won't dispense it until we have our hands on a copy of that sleep test," said Scott Lloyd, president of Extrakare in Norcross, Ga. "We've had a num- ber of these requests, but it hasn't been a huge chal- lenge." Andrea Stark But for provider Kim Brummett, the "one- sies and twosies" have snowballed into 1,900 requests. Scott Lloyd "The flood gates just opened," said Brummett, vice president of con- tracting and reimburse- ment for Greensboro- based Advanced Home Care and a member of AAHomecare's Audit Task Force. "I have four people doing nothing but pulling sleep studies." AUDITS SEE PAGE 31 PEDIATRICS 'Exhausting but rewarding' BY THERESA FLAHERTY, Managing Editor CEU ARTICLES can be downloaded from Dorland's website. UroMed, health publisher join forces on CEUs BY THERESA FLAHERTY, Managing Editor SUWANNEE, Ga. – At UroMed, improving the quality of life of customers also means improving the quality of health education available to medical professionals. The mail-order provider recently part- nered with a health publications company on a urological health continuing educa- tion series for clinicians. "We want to help extend the knowl- edge available to professionals in this field," said Lisa Wells, director of market- ing for UroMed. "When we do that, we are improving the level of care for the people UROMED SEE PAGE 31 COLUMBUS, Ohio – For provider John Reed, the workdays are long and demanding, but he says it's "like being on vacation." The difference is that he now spends those long days focused on patient care, rather than trying to "squeeze the last nickle out of the labor force," he says. Reed, the former CEO of Cincinnati, Ohio-based Pro2 Respiratory Services, co-founded Central Ohio Specialty Care (COHSC), which coordinates and provides care for medically fragile children, last fall. "I had a great run with Pro2, but I didn't want to be in the middle of (competitive bidding)," said Reed. COHSC will provide everything from ventilators, oxygen and enteral nutrients to alarm systems and custom seating. Offering a one-stop shop lets parents focus on caring for their child, said co- founder Nick Kalogeras. "We've heard these parents can spend 30 or 40 hours a month dealing with differ- ent providers," said Kalogeras, a pharmacist who most recently worked at Columbus Prescription. "We give them our number, they call us and it's done." The primary payer for pediatric patients is Medicaid, which is better than Medicare but still has its cons, said Reed. "The guidelines are clear, there's a prior authorization process, and you have an idea of what you are going to get paid for," he said. "What's problematic is that cover- age (guidelines) are often built around the Medicare benefit." That can mean sharply limited coverage for some items, said Reed. For example, One-stop shop model lets parents focus on the child. COHSC provides trach tubes that can cost a few hundred dollars each but are reim- bursed at $47. The provider offsets the loss with other items. "We have the ability to balance five or 10 loss leaders in a package because we do 60 or 70 items (for each patient)," said Reed. COHSC serves a 60-mile radius that includes two major children's hospitals that serve as major referral sources. Other referrals come from nursing agencies and, perhaps the most important, the families. "These families have a pretty unique bonded network," said Reed. "They go PEDIATRICS SEE PAGE 30 Off-the-shelf list 'double- edged sword' BY THERESA FLAHERTY, Managing Editor BALTIMORE – CMS in February released a list of off-the-shelf (OTS) orthotic codes, and it's a good news-bad news scenario, say stakeholders. The good news: The list clarifies what CMS considers to be OTS orthotics. Providers aren't required to have special certification for OTS, as they do for cus- tom items. "It's never been put in writing, and for pro- viders, it depends on who they talk to if they can provide it or not," said Kelly Wolfe, CEO of Regency Billing and Consulting. "(Providers) will feel some comfort level knowing that they can provide them." CMS released the list, which was open for comment until March 16, in response to confusion within the industry over which products have to be provided by certain qualified individuals. C. Zacharias ORTHOTICS SEE PAGE 30