Issue link: https://read.dmtmag.com/i/36987
News 4 HME NEWS / AUGUST 2011 / WWW.HMENEWS.COM OIG lambastes marketing, subcontracting practices Agency raises eyebrow at arrangements between HME providers and sleep labs BY LIZ BEAULIEU, Editor WASHINGTON – The Office of Inspector Gen- eral (OIG) took a recent request for an advisory opinion as another opportunity to put HME providers on watch, industry FEAR FACTOR: Will lawmakers target HME as part of Medicare cuts? BY THERESA FLAHERTY, Managing Editor WASHINGTON – At press time, lawmakers were still in debt ceiling negotiations, seeking $2 trillion in spending cuts. “It’s all closed door dis- cussions,” said Cara Bachen- heimer, senior vice president of government relations for Invacare. “The problem is, they are looking for money and everything is potentially on the table.” Word had leaked in mid- July about some of the pro- posals lawmakers were said to be considering. Those proposals of interest to the HME industry: apply- ing Medicare competitive bidding rates to Medicaid; pre-pay reviews for power wheelchairs; and reductions in pharmacy payments for FEAR SEE PAGE 8 HME providers can play ‘vital role’ in ACOs BY THERESA FLAHERTY, Managing Editor WASHINGTON – Industry stakeholders in early June weighed in on CMS’s proposed rule on accountable care organiza- tions (ACOs). “We suggested that the ACO structures should include homecare and HME as an element,” said Wayne Stanfield, executive director of NAIMES, which submitted comments. “DME providers play a vital role in reducing hos- pital readmissions.” The Affordable Care Act of 2010 included a provi- sion that would incentiv- ize hospitals and physi- cians to work together—as ACOs—to keep patients out of the healthcare system as much as possible. CMS issued a proposed rule outlining how it plans to implement the provision April 7. HME providers are not explicitly mentioned in the proposed ACOS SEE PAGE 10 “If this is a trend that is going to take off, we want to ensure that HME providers have the ability to participate” Ms. Wheelchair 2011 delivers keynote speech at NCAMES meeting Alexandra McArthur, Ms. Wheelchair America 2011, poses with North Carolina Association for Medical Equipment Services Executive Director Beth Bowen. McArthur, a North Carolina native, gave the keynote speech at NCAMES’s summer meeting held June 15-17 in Wrightsville Beach. “We haven’t had anything but positive feedback,” said Van Products Mobility CEO Tim Harrell, whose company has sponsored the Ms. Wheelchair appearance two years in a row. ‘You are still persevering’ Other buzzwords at Heartland Conference: competitive bidding, audits, technology BY THERESA FLAHERTY, Managing Editor WATERLOO, Iowa – For HME pro- viders who feel as though every workday is a battle, the keynote speaker at The VGM Group’s Heartland Conference in June put things into perspective. “In Mogadishu, if you get up in the morning, call it a win in pencil, because you’ve still got the rest of the day (to get through),” Sgt. Matthew Ever- smann told attendees. Eversmann received a Bronze Star for his service in Somalia, where he was involved in the HEARTLAND SEE PAGE 8 attorneys say. In the advisory opinion, posted June 21, the OIG touches on a number of its favor- ite sticking points with providers, includ- ing subcontracting and, for two long para- graphs, marketing. “The tone of the whole opinion is, ‘We don’t like what you’re doing,’” said Asela Cuervo, a Baltimore-based healthcare attorney. A provider, whose name was redacted, requested the OIG’s opinion on two arrange- ments: The first, an existing arrangement, involves the provider consigning CPAP devices to a sleep lab and paying the lab a per-patient fee based on fair market value for set up and education for non-Medicare patients; the second, a proposed arrange- ment, involves the provider paying the lab a flat monthly or annual fee for the same OIG SEE PAGE 6 BRIEFS AAHomecare hires membership director ARLINGTON, Va. – AAHomecare has tapped Dan Smith for its newly created posi- tion of director of membership sales and marketing, the association announced June 22. Smith has many years of expe- rience in the home medical equipment industry, including 12 years at The MED Group, where he served as vice presi- dent of membership from 2002 to 2009. Smith has also held positions at MK Bat- tery, Advacare Medical and Everest & Jennings. His most recent position was at OSI/Overland Solutions Inc., an out- source provider to the insurance market for audits, surveys, loss control and risk management. Providers get 02 claims right—half of the time FARGO, N.D. – Fifty percent of 2,451 claims submitted in Jurisdiction D for HCPCS codes E1390 and E0431 from February 2010 to May 2011 were denied, accord- ing to a widespread prepayment review by DME MAC Noridian Administrative Services. The top five reasons for denial: requested documentation was not pro- vided within the allotted time frame; no office visit notes to determine medical necessity within 30 days of certification or 90 days within recertification were submitted; no/invalid qualifying blood gas study submitted; no documentation to support diagnosis; and no documen- tation to support alternative treatment was tried/considered. Consumer groups: Don’t tax HME WASHINGTON – Eighteen consumer and disability related organizations sent a letter to U.S. Treasury Secretary Timo- thy Geithner on June 7 to request that home medical equipment be exempted from the medical device tax provision in the Affordable Care Act. AAHomec- are reported in a bulletin that the letter was signed by, among others, the ALS Association, the Christopher and Dana Reeve Foundation, and the United Spinal Association. The Lewin Group pockets $2.3M to reduce re-admissions FALLS CHURCH, Va. –The Lewin Group an- nounced in June that CMS has awarded it $2.3 million for the first year of a five-year program to assist hospital and communi- ty-based organizations reduce re-admis- sion rates. Hospitals and organizations participating in the community-based Care Transitions Program seek to improve the transition of Medicare beneficiaries from inpatient hospitals to home or other care settings; improve quality of care; re- duce hospital re-admissions for high-risk beneficiaries; and achieve measurable savings for the Medicare program. Medicare fraud on everyone’s agenda ................ 1 Pilot program called ‘cutting edge’ . . . . . . . . . . . . . . . . . . . 1 NewsPoll: Providers try to improve denial rates ........ 6 State news: Tenn., Ga .......................... .10-11 ■ OIG slams subcontracting arrangements with sleep labs, says Jeff Baird. See story this page. BRENT MATTOX, NCAMES MEMBER