ADVERTISEMENT
| View this email as a Web page | Please add HC_HomeCare Monday_ to your Safe Sender list. |
|
|
|
| A Penton Media Property | |
| August 4, 2008 | Volume 14, Issue 35 |
|
ADVERTISEMENT
|
|
|
ADVERTISEMENT Brightree is the #1 choice of HME/DME providers, outpacing all competitive products combined. Brightree's Internet-based business management solution eliminates technology hassles while helping you to get paid faster and manage inventory better. World class support 24X7 keeps everything humming along. Free demos daily. Click here or call 1-888-598-7797 ext. 5.  Table of Contents - Combating Fraud and Abuse: What's Next in the Battle - STOP Act Aims to Curb Medicare Fraud - California Medi-Cal Cuts Remain in Effect - NBC Roast Fuels Cries For Positive PR - HME Company Newswire - Open Door Forum Rescheduled; Weems to Keynote NGS Convention For more industry news, features and highlights from our latest issue, please visit our Web site at www.homecaremag.com. Headline News Combating Fraud and Abuse: What's Next in the Battle ATLANTA--Amid its trumpeting of the need to squelch fraud and abuse in Medicare's DME sector, CMS has recently taken steps that some industry stakeholders see as contrary to the cause--namely, reappointing Palmetto GBA as the National Supplier Clearinghouse and dropping accreditation deadlines for round two of competitive bidding. The American Association for Homecare has been vocal about the organization's stance on both Palmetto's continuing contract and the discarding of the accreditation dates. On each count, AAHomecare leadership says CMS is essentially shooting itself in the foot when it comes to preventing fraud and abuse. “You have to wonder whether the focus on DME is designed to shift attention away from the failure of CMS to use its existing authority and tools at its disposal to ferret out and stop fraud against Medicare,” said AAHomecare President and CEO Tyler Wilson. “CMS has just renewed its contract with Palmetto GBA, the private company that serves as the National Supplier Clearinghouse for Medicare. Palmetto serves as the gatekeeper for issuing and renewing DME Medicare billing privileges and is required to establish and maintain programs to prevent and detect fraud. The renewal raises the question, 'Why is a contractor that has failed miserably being rewarded with another contract?'” In reference to mandatory accreditation, AAHomecare issued a statement declaring its opposition to the CMS decision to drop the round two deadlines: July 21, 2008, for providers who wished to submit bids; and Jan. 14, 2009, for those who wanted to be considered for contracts. (See HomeCare Monday, July 28.) Reasoned Wilson, “Accreditation for this industry is 30 years overdue. If the federal government wants to get serious about preventing fraud and preventing theft of taxpayer dollars, it should use tools like accreditation more aggressively and use its ample, existing authority much more effectively.” Some Republican senators are looking at the fraud issue on their own. On Monday, the Senate Republican Conference held a hearing on Medicare fraud presided over by Sens. John Cornyn of Texas and Mel Martinez of Florida. While the hearing was designed to address Medicare fraud on all levels, AAHomecare's Michael Reinemer, vice president of communications and policy, said the meeting missed its mark. “To their credit, the number of senators that spoke pointed out that Medicare fraud cuts across a wide spectrum of areas including physicians, labs, dentists, billing agencies--not just DME. And to his credit, [Iowa Sen. Charles] Grassley mentioned three or four reasons why competitive bidding was halted related to the exclusion of providers and all of the administrative snafus that occurred,” said Reinemer, who attended the hearing. “However, the witnesses trotted out the same sorry litany of DME examples, even though by their own accounting, DME fraud represents less than 1 percent of the total [annual] Medicare fraud. “This hearing should have focused on the real, significant causes of fraud. Instead, there were just some passing references to other areas [of fraud] but they spent an inordinate amount of time on wheelchairs and oxygen. It was way disproportionate to their own accounting of where the majority of the fraud is occurring,” Reinemer said. According to government figures, Medicare loses approximately $70 billion annually to fraud. Of that, approximately $700 million--less than 1 percent--is from fraudulent DME claims. The focus on DME, Reinemer said, is “absurd.” “The DME fraud, while abhorrent, is like a pimple on an elephant. If it wasn't so tragic it would be comic that these guys spent so much time looking at the pimple and not the elephant,” he said. Regarding CMS' recent actions, Joan Cross, director of operations at Bradenton, Fla.-based C&C Homecare and former president of the Florida Association of Medical Equipment Services (FAMES), said she approves of Palmetto's contract renewal and feels that the Sept. 30, 2009, mandatory accreditation deadline for all DMEPOS providers is acceptable. “I liked CMS re-signing Palmetto,” said Cross, who serves as chairman of the industry's National Supplier Clearinghouse Advisory Council. “Better the devil you know ... They may not always be able to do something about [a problem], but they do take it back to CMS. They seem to be trying really hard to do a good job. It's hard. It's a big industry. We don't need any more changes.” She went on to say that, while "accreditation is certainly closer to the answer for fraud than anything they've done thus far," she doesn't think elimination of the round two accreditation deadlines is a major concern. “What difference does [it] make? Everyone has to be accredited by Sept. 30, 2009. That's only one year from now," Cross said, "so what's the big deal [with dropping the other dates]?” All parties agree, however, that something must be done to combat Medicare fraud. Reinemer said AAHomecare is making some progress with legislators. “We are working with Sen. Cornyn and Sen. Martinez toward some common-sense solutions to preventing fraud. There are some constructive conversations … trying to ensure that anti-fraud initiatives are effective and aimed at the right areas,” Reinemer said. He also said that a new bill--the Seniors and Taxpayers Obligation and Protection Act (S. 3164) introduced in June by Cornyn and Martinez--may yield some positive results. The bill “is about helping to prevent fraud at the front end of the process,” Reinemer said. “It's designed to implement some screens at the front end before payment is made instead of the current system of 'pay and chase' where you pay and then try to track them down afterwards,” Reinemer said. According to AAHomecare, the "STOP" bill would establish a system for unique identifiers of certain durable medical equipment, urge HHS to implement the DME surety bond requirement that was enacted in the Balanced Budget Act of 1997, require monthly verification of the accuracy of charges for physicians’ services, provide for a study of real-time data review and amend the Medicare enrollment application. For a summary of the bill's provisions, see "STOP Act Aims to Curb Medicare Fraud" in this issue. Do you agree with the recent LCD that eliminates HME providers from involvement in home sleep testing? To vote in HomeCare's monthly Web poll, visit www.homecaremag.com. STOP Act Aims to Curb Medicare Fraud WASHINGTON--In a Senate conference on Monday, Sens. Mel Martinez, R-Fla., and John Cornyn, R-Texas, discussed the need for the federal government to shift its policies regarding Medicare fraud. In June, the senators introduced the Seniors and Taxpayers Obligation Protection Act of 2008 (S.3164), or STOP Act, which they said will give federal agencies the tools they need to crack down on fraud before it occurs. “Our bill will give agencies the tools to stop fraud at the front end rather than having the Department of Justice get involved at the back end after the fraud has occurred,” said Martinez. “Instead of continuing the current practice of pay and chase, the federal government needs to shift to a policy of detect and prevent.” The bill would help to improve HHS' detection methods and place billing statements under increased scrutiny, the senators said. While HME stakeholders said the proposal could be promising in curbing Medicare fraud in general, some worried that the senators' frontal attack might focus only on DME. (See “Combating Fraud and Abuse” in this issue.) A statement from Martinez about the legislation singled out the sector, noting that “items such as durable medical equipment are notoriously known to be falsely billed at taxpayer expense--often to fake companies with nothing more than a P.O. Box.” Under the measure, HHS would identify the 50 counties most vulnerable to fraud based on the degree of county-specific reimbursement and analysis of payment trends. These counties would be designated as “high-risk areas.” In addition, the legislation would: --Require monthly verification of the accuracy of charges for Part B claims from physicians in high-risk areas. At the end of each month, HHS would provide physicians and group practices with a detailed list of claims that were submitted to review and verify. --Require HHS to implement prepayment fraud detection methods in high-risk areas, including:
--Require HHS to conduct a study on the use of technology (similar to that used in the analysis of credit card charging patterns) to provide real-time data analysis of claims to identify and investigate unusual billing or order practices that could indicate fraud or abuse. The study would address whether such technology could be used to identify unusual billing or order practices by an individual supplier or for a certain HCPCS code in a particular area without alerting potentially fraudulent providers and allowing them to escape. The study would also look at how such technology could provide for the timely review of claim logs. --Require HHS to require carriers, prior to paying a DMEPOS claim, to confirm with the National Supplier Clearinghouse that the Medicare identification number of the supplier is active. HHS would establish an online database similar to that used for the National Provider Identifier “to enable providers of services, accreditors, carriers and the NSC to view information on specialties and the types of items and services each supplier has indicated on the CMS-855S Medicare enrollment application submitted by the supplier.” --Require that HHS establish a tracking system for certain DME with the label of such equipment to bear a unique identifier, or serial number. After issuing an item to a supplier, manufacturers (or wholesalers) would develop a product description for the item including its unique identifier, HCPCS code, the name of the supplier the item was shipped to and the supplier's Medicare identification number. HHS would set up and maintain a database with these unique product identifiers, and manufacturers would submit the product descriptions they developed to HHS for storage in the database. --Direct HHS to put the surety bond requirement for suppliers enacted under the Balanced Budget Act of 1997 in place within six months of the enactment of S. 3164. In February, Martinez, Cornyn and several other senators proposed upping a surety bond requirement for DMEPOS providers to $500,000. But after an outcry from industry groups saying the measure would cause undue hardships on small providers, the senators quickly said they would reconsider. A section of the BBA requires a $50,000 surety bond for DME providers as a deterrent to fraud and abuse. However, the government never implemented the requirement, and in July of last year, CMS proposed a $65,000 bond be required. The agency said that amount was an inflation-adjusted figure from the $50,000 amount included in the 1997 law. (See HomeCare Monday, Feb. 25.) The STOP Act also requires HHS to change the current system of using Social Security numbers as the Medicare Beneficiary Identifier used on Medicare cards. “This will lead to less fraud and greatly reduce identity theft among our seniors,” said Martinez. “It will also allow seniors and the government to easily take a Medicare recipient's number out of circulation when fraud is detected.” “Our bill represents a first step in fighting Medicare fraud, and will put us on the right track to saving taxpayer money and protecting our seniors,” Cornyn said. “I hope that everyone will notice the urgency of this issue and make it a top priority. Our seniors, our providers and our taxpayers deserve better accountability from Medicare.” The bill has been referred to the Senate Finance Committee, which oversees Medicare. For the full text of the Seniors and Taxpayers Obligation Protection Act of 2008, go to http://thomas.loc.gov and enter “S. 3164” in the search bar. California Medi-Cal Cuts Remain in Effect LOS ANGELES--On Tuesday, a California Superior Court judge failed to stop an across-the-board 10 percent Medi-Cal cut for services provided after July 1. The Alliance for Patient Choice, a coalition of more than 100 health care provider organizations in the state--including the California Medical Association, the California Hospital Association and the California Pharmacists Association--had asked for a preliminary injunction against the Medicaid reimbursement reductions, which were enacted in February as part of a plan to prevent a $17 billion state budget shortfall. While the court found the cuts did present “a substantial showing of actual harm which will likely occur as a consequence of the reimbursement reductions,” Superior Court Judge William F. Highberger rejected the argument that the reduction violated state and federal law because it would deny equal access to services for Medi-Cal beneficiaries. He also ruled that CMS' approval before the rate cuts were implemented was not necessary. The providers had argued that the cuts were invalid because they required the approval of CMS, and the state's Department of Health Services had not sought that approval or conducted an analysis of the payment reductions' impact on access. The Medi-Cal program provides health services to approximately 6.6 million low-income Californians. According to a July 30 update from the California Association of Medical Product Suppliers, the health care providers who brought the lawsuit described the decision as “an enormous setback for the health and lives of the millions of Californians who rely on the state's safety net.” CAMPS said the coalition of providers is considering filing an emergency appeal with the second district appellate court in Los Angeles. In more bad news for the state's Medicaid program, the association said in its update, “There is no real progress in Sacramento on a budget solution." Earlier this year, the California Senate had voted to reduce the Medi-Cal cut to 5 percent, and the state Assembly eliminated it altogether. But for either alternative to supercede the 10 percent cut, it must be part of the final state budget, which sits at an impasse. Summer Medi-Cal payments were already scheduled to be delayed, and with the budget on hold, providers might have to wait until September for another payment, CAMPS Executive Director Bob Achermann told HomeCare in June. "Without a budget being adopted and signed there will be no Medi-Cal payments," CAMPS said last week, adding that a budget solution "provides real opportunity for the 10 percent cut to be eliminated.” NBC Roast Fuels Cries For Positive PR NEW YORK--Like a bad penny, negative press for the HME industry always seems to turn up--most recently, in a report for NBC by senior investigative correspondent Lisa Myers. The report, which aired July 26 on the “Nightly News with Brian Williams,” had the following introduction: “After being hammered by Congress for wasting taxpayer money, Medicare recently moved to fix the problem. So why was its new program to slash prices on medical supplies and save the government hundreds of millions of dollars stopped dead in its tracks?” The report on the delay of competitive bidding--which included an interview with CMS Acting Administrator Kerry Weems--went on to question why Congress would delay a “Medicare savings bill,” stated that Medicare had been “overpaying” for home medical equipment for years and said industry lobbyists had “spent millions” fighting the bid program. The contentions were countered by Cara Bachenheimer, senior vice president of government relations for Invacare, who also was featured in the report. “Any reduction in the payment level will have a very direct impact on the level or quality of items and services that consumers receive,” she told Myers. But that's almost all she got to say. “I interviewed for 40 minutes and they took eight seconds--very frustrating,” Bachenheimer said. Michael Reinemer, vice president of communications and policy for the American Association for Homecare, said the organization was not contacted about the report, and, upon viewing the NBC segment, he contacted the network. “Myers insists that she did a fair and accurate story,” Reinemer said. “I requested an opportunity to respond or to have a follow-up segment to correct the misconceptions but have not heard back.” In a letter to NBC, Reinemer pointed out the report failed to explain that the Medicare Improvements for Patients and Providers Act of 2008, which delays competitive bidding, includes a 9.5 percent across-the-board reimbursement cut that will be effective next year and also ensures providers “will forgo a CPI reimbursement adjustment, which will, according to the Congressional Budget Office, completely offset and possibly over pay for the savings that the flawed bidding program would have reaped,” he wrote. The story also failed to account for the services involved with HME and instead relied on the often-used quotes that pit retail costs for equipment against reimbursement rates, Reinemer said. “The higher price in Medicare offsets the delivery and services tailored to the Medicare beneficiary, who is in the cheapest care setting possible--his or her own home,” his letter pointed out. The NBC report is just the latest in a series of stories unfavorable to HME that some feel have contributed to the industry's negative image in Washington. “Like it or not, our industry continues to be perceived in a very negative light on Capitol Hill,” Bachenheimer said. “Whether it is the succession of negative and continuing Office of Inspector General and General Accountability Office reports, neither the source nor the validity is relevant. What does matter is that the perception is real and pervasive.” She also said HME needs its own public relations campaign to highlight the industry's positive contributions. Industry groups have already stepped up communications efforts. Reinemer said AAHomecare's ongoing “Stand Up For Homecare” campaign is making strides, contacting legislators and the consumer media in attempts to get positive messages about HME to the public. The group is planning its third annual fundraiser for the campaign during Medtrade in October. But there remains much room for progress, Reinemer said. “We have been battling the CMS talking points on this virtually all year now, and we'll continue,” he said. For information on the fundraiser, visit www.aahomecare.org. HME Company Newswire HME Company Newswire Q2 Revenues Down at American HomePatient BRENTWOOD, Tenn.--On Thursday, American HomePatient announced revenues for the second quarter ended June 30 decreased 12.4 percent compared to the same quarter in 2007. Revenues for the quarter were $64.2 million compared to $73.3 million in 2007, a decrease of $9.1 million. Revenues for the six months were $133.4 million compared to $150.3 million for the same period in 2007, a decrease of $16.9 million, or 11.2 percent. The decreases were primarily attributable to a change in inhalation drug product mix and the company’s reduced emphasis on less profitable product lines such as nonrespiratory DME and infusion therapy, according to a statement. In addition, initiatives designed to improve patient co-pay collections and provide appropriate service levels to patients were unprofitable, the company said. Operating expenses for the quarter compared to 2007 declined by approximately $1.0 million, or 2.8 percent, while operating expenses for the six months compared to the same period last year declined by $1.7 million, or 2.4 percent. The decreases were the result of efficiencies that helped reduce operating costs, the company said. Apria Postpones Investor Call
In preliminary results, the company said second quarter revenue grew over the prior year by 35.5 percent to $531.2 million from $391.9 million in 2007. Q2 net income was $22.6 million, an increase of 17.4 percent, compared to $19.3 million in the second quarter last year. Cross-Country Move for CHAD
“The combination of CHAD's leadership position and Inovo's manufacturing expertise will allow CHAD to continue in the tradition of innovation and excellence,” said Inovo CEO George Harris. “With 100 percent of our time and energy devoted to oxygen conservation, we are able to focus on this segment of the industry, identify needed improvements, and deliver technological advancements quickly and efficiently.” Faced with rising delivery costs and cuts in oxygen reimbursement, home medical equipment providers are dependent upon the ability to respond quickly and effectively to changing market conditions. “We obviously have a vested interest in their success,” said Harris, “so it is imperative that our business objectives are aligned with their needs.” CHAD offers a broad line of electronic, pneumatic and disposable oxygen conservers. Inovo has manufactured both regulators and conservers for the private-label market for over 10 years. LifeScan, ResMed Partner on Diabetes, SDB Education
The agreement between the two companies comes on the heels of a recent announcement by the International Diabetes Federation about the correlation of type 2 diabetes and SDB. “Through this agreement, it's our hope to make significant inroads into educating more physicians about the coexistence, identification and care of these two diseases, and getting more patients diagnosed, treated and on the road to a healthier future,” said Tom West, president North America, LifeScan. Lincare Sees Revenue Jump
Revenues for the six months were $843.8 million, a 9 percent increase over $775.5 million for the comparable period last year. Net income for the period was $!23.3 million this year compared to $109.9 million for the first half of 2007. The company said revenues and earnings were impacted by a change in order patterns for certain inhalation drugs. In April, CMS' DME MACs issued a revision of the nebulizer local coverage determination that would have effectively eliminated Medicare reimbursement for the drugs as of July 1. As a result of the potential loss of access, the company said a significant number of its customers placed orders in June to receive a 90-day shipment of the drugs rather than a 30-day shipment. According to a company statement, the net effect of the ordering change was to accelerate approximately $18.9 million of revenues in the second quarter that would otherwise be expected in the third quarter. CMS subsequently delayed implementation of the LCD, but Lincare said it now expects third quarter revenues will be reduced by amounts similar to those that increased in the second quarter. The company added 10 new operating centers during the second quarter, bringing the total number of locations to 1,039. Lincare also completed the acquisition of a small infusion therapy provider in Mississippi during the quarter. Otto Bock Drops OrthoRehab Name
In other company news, Chuck Grosso will assume the newly created position of national sales director for Otto Bock's Orthopedic Services business area, including responsibility for the national roster of certified patient service representatives who provide in-home delivery and care. Now marking its 50th year of operation in the U.S., the 80-year-old Germany-based Otto Bock produces over 25,000 types of prosthetic, orthotic, mobility and rehabilitation products. Pride, MED Sign New Contract
According to John Burks, MED Group's senior vice president of supplier relations, Pride's “combination of being the high-quality and cost efficient manufacturer, coupled with the exceptional work that they do to support our industry was key motivation to renew our agreement well before expired.” In Brief Open Door Forum Rescheduled; Weems to Keynote NGS Convention CMS has rescheduled its next Home Health, Hospice & DME Open Door Forum for Wednesday, Aug. 13. The session will begin at 2 p.m. EDT. To participate by phone, call 800/837-1935 and use conference ID 55463424. Acting CMS Administrator Kerry Weems will be the keynote speaker at National Government Services' Medicare Convention 2008, set for Aug. 25-28 at the Indiana Convention Center in Indianapolis. NGS is the Jurisdiction B DME MAC for providers in Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin. Registration for the convention is open through Aug. 8 at www.NGSMedicare.com/ngsmedicare/ConventionRegistration.aspx. In a final rule issued Thursday, CMS said hospices serving Medicare beneficiaries will see a 2.5 percent increase in payment for 2009. The increase in the hospice wage index is the net result of a 3.6 percent increase in the market basket indicator of cost, offset by a 1.1 percent decrease in payments to hospices as CMS phases out a transtional payment to these providers. The U.S. health care system has failed to improve overall and access continues to decline according to a report called “Why Not The Best? Results From The National Scorecard on U.S. Health System Performance, 2008.” In the report, from The Commonwealth Fund, the U.S. scored an average of 65 out of 100 across 37 key indicators. The previous score, from 2006, was a 67. Among the report's findings, the U.S. ranks last among the 19 industrialized nations in premature deaths that could have been prevented. Efficiency performance received a 53 out of 100 due to “widespread delivery of inappropriate and wasteful care throughout the U.S., including potentially avoidable hospital admissions, minimal use of information technology and high administrative costs.” The U.S. also lags behind in electronic records, with only 28 percent of the country's doctors utilizing the technology. To revisit this news any time during the week, go to www.homecaremonday.com. ADVERTISEMENT |
|
About this Newsletter You are subscribed to this newsletter as #email# To unsubscribe from this newsletter go to: Unsubscribe To subscribe to this newsletter, go to: Subscribe To visit HomeCare's Web site click here For information on advertising in this newsletter, please contact Kent Peterson, National Sales Manager/Western Region Sales at kpeterson@homecaremag.com, or John McNamara, Regional Sales Manager/Eastern Region Sales at jmcnamara@homecaremag.com. |
|
|
|
To get this newsletter in a different format (Text or HTML),
or to change your e-mail address, please visit your profile
page to change your delivery preferences.
For questions concerning delivery of this newsletter, please contact our
Customer Service Department at: Penton Media | 249 W. 17th Street | New York, NY 10011 Copyright 2008, Penton Media. All rights reserved. This article is protected by United States copyright and other intellectual property laws and may not be reproduced, rewritten, distributed, re-disseminated, transmitted, displayed, published or broadcast, directly or indirectly, in any medium without the prior written permission of Penton Media. |
