IOM Report Calls for Universal Health Coverage by 2010
WASHINGTON--Given the growing stress placed on the nation's health care system and the substantial costs from more than 43 million Americans' lack of health insurance, the president and Congress should strive to achieve universal health coverage by 2010, according to a report from the Institute of Medicine of the National Academies.

"Lack of health insurance in the United States is a critical problem that can and should be eliminated," said Mary Sue Coleman, president of the University of Michigan and co-chair of the IOM committee that wrote the report. "Achieving universal coverage will require federal leadership and support, regardless of which strategy is adopted to achieve this goal."

IOM is a private, nonprofit institution that advises federal policymakers on health policy under a congressional charter granted to the National Academy of Sciences. Its report, Insuring America's Health: Principles and Recommendations, said that the country loses $65 billion to $130 billion annually as a result of the poor health and early deaths of uninsured adults, and found that 18,000 unnecessary deaths occur each year because of lack of health insurance. In addition, the report concluded, tax dollars paid for an estimated 85 percent of the roughly $35 billion in unreimbursed medical care for the uninsured in 2001.

The IOM panel, which was charged with assessing the nation's current approach to health insurance, did not endorse any specific strategy for expanding health coverage to all Americans, but did offer five principles on which to judge any such proposal: 1) health care coverage should be universal; 2) health care coverage should be continuous; 3) health care coverage should be affordable to individuals and families; 4) the health insurance strategy should be affordable and sustainable to society; and, 5) health care coverage should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered and equitable.

Speaking to reporters earlier last week, U.S. Department of Health and Human Services Secretary Tommy Thompson said that universal coverage by 2010 is unrealistic, both administratively and legislatively. "I just don't think it's in the cards," he said.

For a copy of the IOM report, visit http://www.iom.edu/report.asp?id=17632.

HIPAA TCS Compliance Reaches 58 Percent
Percent BALTIMORE--As of Jan. 2, 58 percent of electronic claims Medicare received were in the transaction code set (TCS) format required by the Health Insurance Portability and Accountability Act, the Centers for Medicare and Medicaid Services said during a home health, hospice and DME Open Door Forum Wednesday.

The TCS rule was set to take effect Oct. 16, 2003, but by mid-September last year, fewer than 11 percent of the electronic claims that Medicare received were HIPAA-compliant. As a result, the agency implemented a contingency plan to ease the deadline and ensure continued processing of claims.

Although no new deadline has been announced, according to a CMS spokesperson at the Open Door session, "The contingency plan is only temporary. CMS is closely following progress on compliance and will be ending the contingency as soon as we can." She added that the agency expects a provider to move into full compliance within 30 days following testing of the system. "Providers who do not meet this time frame must work with their Medicare contractor one-on-one to establish an acceptable timeline," she explained.

Additionally, CMS recently instructed its contractors to require HIPAA-compliant claims from all providers new to Medicare. "In other words," the spokesperson stated, "this contingency plan is not applicable to new providers."

The agency said, however, that the requirement does not apply to certain small providers exempt from filing electronic TCS-compliant claims.

For more information on HIPAA, visit http://www.cms.gov/hipaa or call (866) 282-0659.

To revisit this news any time during the week, go to http://www.homecaremonday.com.

Georgia, Nevada Report Computer Problems with Medicaid Payments
ATLANTA--Since April 2003, Georgia providers have been filing electronic Medicaid claims based on ANSI standard HIPAA-compliant software. Unfortunately, receiving payment for such claims has been anything but smooth, according to Mike Hamilton, executive director of the Georgia Association of Medical Equipment Services (GAMES).

"It's been a disaster," Hamilton said. "Dozens of suppliers in Georgia ... have been unable to get paid."

Last week, Phoenix-based consultants FourThought Group reported to the state's Department of Community Health, which administers Georgia's Medicaid program, that not all claims were paid correctly and payments were not sent to the correct providers. The state has a contract with Dallas-based Affiliated Computer Services to process Medicaid claims.

If a percentage of unpaid claims on-hand is significantly higher than paid claims for a given week for a particular provider, state claims processors have sent that provider payments equal to those received at the same time during the previous year, Hamilton said. "It gives you some cash," he added, "but you don't know where to apply it. It's an accounting nightmare. For a new or rapidly growing company, those interim payments are going to be far short."

Another Medicaid payment problem is occurring in Nevada where a state contractor, Downers Grove, Ill.-based First Health Systems, implemented a new HIPAA-compliant computer system last October, according to the Nevada Association of Medical Product Suppliers (NAMPS).

One major concern has been errors with billing cycles, explained NAMPS President Rich Pozensky. The system's billing cycles were based on calendar months--Nov. 1 to Nov. 31--and not on one-month anniversaries--Nov. 15 to Dec. 15, for example--creating a billing nightmare for providers of oxygen and other HME.

"Nobody knew this when we started our [electronic] billing for Medicaid," Pozesky said, adding that "all the vendors are going to have to re-bill all of their claims" since Oct. 1. He also noted that the problems are being worked out, and that "most of the major headaches" should be resolved by the end of the month.

The state has given First Health Systems until Feb. 5 to correct the problems, after which the company will incur monetary penalties, Pozesky said.

Manufacturer News
Abbott to Acquire TheraSense for $1.2 Billion
ABBOTT PARK, Ill.--Abbott Laboratories said Jan. 13 that it will acquire diabetes test-maker TheraSense Inc., which manufactures FreeStyle blood glucose self-monitoring systems, for $1.2 billion.

TheraSense, Alameda, Calif., entered the market in mid-2000 and has specialized in products requiring very small blood sample sizes. The company has requested FDA clearance to market its FreeStyle Navigator, which is designed to provide real-time glucose data, hypo- and hyperglycemic alarms and trend analysis. The device continuously monitors glucose levels and transmits the results to a wireless receiver small enough to be carried in a pocket. Another TheraSense product, the CozMore Insulin Technology System, is under development with Deltec Inc., which provides infusion systems. Set to launch this year, the system combines the TheraSense glucose testing system and insulin delivery options if blood-sugar levels are too high.

"Together with TheraSense, Abbott can build on its success in the blood glucose monitoring business," said Ed Fiorentino, president, MediSense Products, Abbott Laboratories. Abbott entered the field in 1996 with the acquisition of MediSense, which was the first company to commercialize biosensor technology, and grew with its product, Precision QID.

Abbott said it would continue to promote both MediSense and TheraSense products. The transaction is expected to close during the second quarter of 2004.

Invacare Acquires Infusion Therapy Distributor
ELYRIA, Ohio--Invacare said last week that it has acquired the assets of ACS, a Deer Park, N.Y.-based division of Mediq PRN Life Support Services, which distributes medical supplies with a focus on infusion therapy. Terms of the cash purchase were not disclosed.

ACS will be combined with Invacare Supply Group's current distribution business, headquartered in Holliston, Mass., and ACS' sales and customer service personnel will be employed by ISG. The company's distribution system will be consolidated into ISG over the next several months.

"We are very pleased to have a business with a strong supplies position in infusion therapy joining Invacare," said Malachi Mixon, chairman and CEO.

Also commenting on the acquisition, Mike Perry, vice president of ISG, said ACS' sales and customer service personnel have the capability to help ISG increase its market share in the supplies industry.

Vantage Mobility Acquires Ricon Corp. Personal Division
PHOENIX--Vehicle accessibility-products manufacturer VMI (Vantage Mobility International) has purchased the Personal Division of Los Angeles-based Ricon Corp., including the company's platform lift and adaptive accessories product lines. According to VMI, the addition will complement its existing specialties in lowered-floor mini-vans, lowered-floor full-size vans and stowage lifts.

According to VMI CEO Mitch Vance, the acquisition "demonstrates our commitment to being the industry's most comprehensive supplier to mobility equipment dealers and durable medical equipment dealers."

Newsmakers
U.S. Department of Health and Human Services Secretary Tommy Thompson has appointed Calise I. Munoz as regional director of Region IX, based in San Francisco. The region includes the states of Arizona, California, Hawaii, Nevada and additional offshore areas. Munoz has served as deputy director for policy in HHS' Office of Intergovernmental Affairs since September 2001.

Coming Up
On Jan. 30 and Feb. 4, Region D DMERC will sponsor free Webinars outlining the clarification of local medical review policy (LMRP) for power wheelchairs and the adoption of a consistent approach to the medical review of power wheelchair claims by all four DMERCs. Each session, offered twice on both dates, will last approximately one hour. For a summary of the program and information about registration, visit http://www.cignamedicare.com/articles/jan04/cope470.html.

Altimate Medical, Morton, Minn., will present "Standing 101," a half-day seminar on standing technology, throughout 2004 in locations around the country. For more information and the schedule of cities and dates, visit http://www.easystand.com/smart/index.html or call (800) 342-8968.

Are You a Top Provider? HomeCare is compiling its list of the nation's top home medical equipment providers, determined by financial and customer service performance from the past year. The list will be published in the April 2004 issue of the magazine. To enter your business for consideration as a top provider, go to http://www.homecaremag.com and click on the Top Providers form button on the left side of the page. Or, look for the form in the January issue of HomeCare. Forms must be received by Feb. 4, 2004.

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