HME News

April 2012

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News 4 HME NEWS / APRIL 2012 / WWW.HMENEWS.COM WASHINGTON UPDATE Online bidding petition seeks 'real change' BY THERESA FLAHERTY, Managing Editor SCARBOROUGH, Maine – Why didn't someone think of this sooner? A petition to stop com- petitive bidding picked up 8,000 signatures in its first two weeks. National Sleep Therapy (NST) launched the petition on change.org in an effort to get beneficiaries and caregivers to speak up about the dreaded program. "I've always thought real change needs PHOTO CREDIT: RODNEY CHOICE, WWW.CHOICEPHOTOGRAPHY.COM JOEL MARX, chairman of AAHomecare and president of Cleveland-based Medical Service Co., and other members of the Ohio delegation met with Republican Rep. Steven LaTourette's chief of staff on Feb. 16. Stakeholders switch gears on Capitol Hill BY THERESA FLAHERTY, Managing Editor WASHINGTON – HME stakeholders in Febru- ary were thrown a curve ball when, on the eve of the AAHomecare Washington Legis- lative Conference, lawmakers announced they were close to a compromise package on the payroll tax cut extension. Stakeholders had planned to ask law- makers to include the market-pricing pro- gram (MPP), an alternative to competitive bidding, in the package during more than 300 meetings on Capitol Hill. "The game's not over," Walt Gorski, vice president of government relations for AAHomecare, told attendees. "Ask lawmak- ers, 'This needs to get done. How do we do it?'" The compromise package, which law- makers passed later that week in February, included a delay to a 27% cut in Medicare CAPITOL HILL SEE PAGE 12 NAIMES hits the West Wing BY THERESA FLAHERTY, Managing Editor WASHINGTON – Key members of the White House health policy staff have reached out to CMS with questions about the competitive bidding program, according to Wayne Stanfield, president and CEO of NAIMES. The communication comes after Stanfield and Wayne Sale, chairman of NAIMES, met with three high-ranking staffers in the West Wing of the White House on Feb. 14. "This was an opportunity that you don't get very easily," said Stanfield. "They wanted to hear what we were saying and they asked a lot of interesting questions." NAIMES SEE PAGE 8 to happen at the patient/voter/constituent level," said Peter Falkson, CEO and cofound- er of NST. "If we could get all the patients involved—the people that actually get the care and benefit from it—they have a much bigger, more important voice than we do as owners of businesses." That voice has been missing, say provid- ers. In fact, CMS has said many times that it has received only a handful of com- plaints from ben- eficiaries, a sign, the agency says, that the program is working. The petition picked up 8,000 signatures in two weeks. "If the beneficiaries aren't speaking out, the assumption is, they are doing OK, they are getting their oxygen, they are getting their wheelchair," said Falkson. Originally, the provider pushed out the petition only to its patient base, but quickly retooled it to create a broader message—and reach a broader audience. In addition to ben- eficiaries, the hope is that other HME pro- viders will ask their own patients to sign the petition and pass it along. Provider Gary Sheehan reached out to about 500 patients who subscribe to his com- pany's patient newsletter. "It's not a heavy lift to blast it out," said Sheehan, president/CEO of Sandwich, Mass.- based Cape Medical Supply. "We figured, why not try and supplement (existing efforts) and get more people aware of the issue?" Still, he acknowledges it's tough to get ben- eficiaries engaged in industry efforts. "The beneficiaries don't really care until you tell them you can't provide to them any more," said Sheehan. HME care providers disclose and return identified overpayments within 60 days to generate con- siderable buzz. CMS published a proposed rule in the Federal Register on Feb. 16 that fleshes out the Beware broad definition for overpayments A BY LIZ BEAULIEU, Editor TTORNEY CARLA Hogan expects new details on a requirement that Medi- requirement, including a broad definition for "overpayment." The agency will accept com- ments on the rule until April 16. "A number of the proposed requirements will be viewed as burdensome, and will gener- ate controversy and comment," said Hogan, a principal and chairwoman of the Health and Employment Practice Groups at Albany, N.Y.-based Tuczinski, Cavalier, Gilchrist & Collura. "The way they define overpay- ments is broad. You could have an overpayment because you billed for something you didn't deliver; you could also have an overpayment because someone put down the wrong date of service. There's a big difference between the two: One may or may not involve fraud; the other is a technical deficiency in the paperwork." Hogan will give a presenta- tion on overpayments on June 27 as part of the "HME Com- pliance Connection" webinar series spearheaded by the Penn- sylvania Association of Medical Suppliers (PAMS) and support- ed by more than a dozen other state associations. Here are a few things that HOGAN SEE PAGE 6 BRIEFS 2013 budget includes familiar DME cuts WASHINGTON – President Obama's pro- posed federal budget for 2013 recycles cuts like limiting Medicaid payments for certain DME in competitive bidding areas to what Medicare pays in those areas. This would save an estimated $3 billion over 10 years. The budget also mentions other familiar provisions, such as requiring face- to-face encounters for DME. Also of note: The budget increases spending for admin- istrative costs at CMS by 25.9%, accord- ing to The Wall Street Journal. Why? The agency says it needs about $864 million to open the federally run health insurance exchange program slated to start in 2014, according to the newspaper. Medicare bennies speak out in Philly PHILADELPHIA – Twenty-one Medicare ben- eficiaries in Philadelphia have signed a letter detailing their fears of competitive bidding. The letter details three areas of concern: receiving timely service, preserv- ing access to local providers, and protect- ing the choice of quality equipment. Feds make record healthcare fraud bust WASHINGTON – A physician and the office manager of his medical practice, along with five owners of home health agen- cies (HHAs), were arrested in February on charges related to their alleged participa- tion in a nearly $375 million healthcare fraud scheme. According to the indict- ment, Dr. Jacques Roy, who owned and operated Medistat Group Associates in the Dallas area, allegedly certified or directed the certification of more than 11,000 indi- vidual patients from more than 500 HHAs for home health services during the past five years. That's more purported pa- tients than any other medical practice in the country. These certificates allegedly resulted in more than $350 million being fraudulently billed to Medicare and more than $24 million to Medicaid. Sen. Lugar: Review bid alternative WASHINGTON – Sen. Richard Lugar, R-Ind., sent a letter to two of his colleagues on the Senate Finance Committee to let them know he supports reviewing and scoring the HME industry's market-pricing program (MPP), an alternative to the competitive bid- ding program. Lugar also asked Sens. Max Baucus and Orrin Hatch to investigate the contradictory claims between the industry and CMS concerning a reduction in jobs and access as a result of the program. Short take AAHomecare announced in February that Julie Driver has joined the association as senior manager of marketing and com- munications. She most recently served as program manager of the Paul D. Coverdell Fellows Program at the Peace Corps. Philadelphia-area bennies get wake-up call. . . . . . . . . . . . 1 Start planning now for ICD-10 . . . . . . . . . . . . . . . . . . . . . . . 6 Q&A: Michele Faulkner ............................ 10 State news: Texas, Illinois. . . . . . . . . . . . . . . . . . . . . . . .12-13 ■ The increase in audits has slowed the appeals process for providers, says attorney Neil Caesar. See story page 8.

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