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Headline News
CMS Proposes Alteration of Billing Number Appeals Process
BALTIMORE--Home medical equipment providers whose supplier numbers have been revoked or denied would be entitled to a hearing before an administrative law judge under a CMS proposal that was published in Friday's Federal Register.

The proposal for changes to the agency's current policy would also entitle those providers to a subsequent departmental appeals board review and judicial consideration of the board's decision.

CMS said the proposal is an effort to "clarify, expand and update our current policy and administrative appeals rights." It would, the agency said, give providers "a measure of protection against adverse actions by us and extend protection to a larger group of suppliers beyond the [durable medical equipment] providers currently covered."

The proposed regulation would also cover independent laboratories, ambulance providers, independent diagnostic testing facilities, physicians and other entities.

"In my opinion, this is a great expansion of the current policy as providers would have the ability to plead their case to an independent person," said Sarah Hanna, a reimbursement consultant and vice president of ECS Billing & Consulting, Tiffin, Ohio. "Prior to this, if [an] application was denied or revoked, the provider had no appeal options."

The current regulation only entitles providers to a Medicare carrier hearing and the option of seeking a review before a CMS official.

The proposal would also require Medicare carriers to notify providers of their billing number revocations or denials by certified mail and include the reason for the denial or revocation "in sufficient detail to allow the supplier to understand the nature of its deficiencies." The provider must also be informed of the right to appeal and the address to which the written appeal must be mailed, according to the proposal.

"It does clarify the process," observed Brian Miller, an attorney with the Health Law Center in Greenville, S.C. "But not all of the clarifications are beneficial [to providers]."

Miller said the new proposal "dumbs down" the notice requirements and also eliminates the current requirement that a hearing be held within one week of a request. While Miller said CMS has seldom honored the one-week hearing stipulation, "I think dumbing down the one process and delaying the hearing are potentially detrimental [to providers]."

But a third key feature is to providers' benefit, he said. CMS is proposing that if a revocation of a provider's billing privileges is reversed upon appeal, those privileges would be reinstated "back to the date that the revocation became effective."

"They're guaranteeing retroactive reinstatement" of billing privileges, Miller said.

The proposal also alters timeframes for providers to file appeals of an adverse determination. Providers would have 60 days to file an appeal rather than the current 90 days; the proposed maximum adjudication timeframe for appeals would be 180 days, except in the case of reconsideration, when it would be 60 days.

The proposal also suggests reducing the time from 60 to 30 days for a provider to furnish complete information requested by a contractor or all supporting documentation in submitting an enrollment application.

Comments on the proposal will be accepted until May 2. To comment electronically, visit http://www.cms.hhs.gov/eRulemaking and select docket ID CMS-6003-P.

Harkin was the chief sponsor of the ADA when it debuted in 1990. His advocacy for the rights of the disabled goes back to his childhood, when his 7-year-old brother Frank became deaf after contracting spinal meningitis and then faced many barriers, both physical and cultural. That bothered Harkin, who has since won a reputation as a champion of rights for those with disabilities.

CMS Revs Up Data Centers, Awards $228M in Contracts to CDS
BALTIMORE--As part of its plan to modernize Medicare operations and lower costs by establishing enterprise data centers, CMS has recently awarded two contracts valued at $228 million.

Last week, the agency awarded a six-year, $28 million contract to Columbia, S.C.-based Companion Data Services for hosting operations to support its 1-800-MEDICARE national data warehouse. The Medicare help line operates 24/7, and customer service representatives answer about 40 million calls each year, according to CDS.

In February, CDS also snagged a $200 million six-year contract to support electronic data processing and hosting operations for approximately 650 million fee-for-service claims submitted in 30 states, the District of Columbia and Puerto Rico. The contract represents the majority share of a CMS task order for the processing of 841 million Medicare claims per year.

CDS said the contract will result in about 40 new jobs at its program management office in Dallas, and 10 new positions at its data center in Columbia, S.C. The additional workload means approximately 54 percent of all Medicare claims will be processed through CDS' data center by January 2008.

Both contracts are part of CMS' plan to consolidate more than 20 current data centers in order to expand electronic services, bolster security and lower costs. In 2006, the agency awarded a 10-year contract to three companies to operate new data centers: CDS, EDS and IBM. The selection qualified those companies to compete for approximately $1.9 billion in work, CDS said.

CDS is a wholly owned subsidiary of BlueCross BlueShield of South Carolina.

Then and Now: CMS Hails Effects of Operation Wheeler Dealer
DALLAS--Sixteen months after the cessation of a concentrated effort to crack power wheelchair fraud in Harris County, Texas, CMS is still seeing a decrease in fraudulent claims, officials said.

"CMS has noted significant changes because of our efforts to curtail wheelchair fraud in Harris County," said Julia Lathrop, special assistant to the regional administrator for CMS in Dallas. "The number of claims for power wheelchairs dropped significantly, the claims denial rate is more appropriate and a number of wheelchair suppliers' Medicare numbers were revoked for various reasons."

While Operation Wheeler Dealer officially ended on Oct. 1, 2005, CMS and its contractors still "monitor wheelchair activities in Harris County on a regular basis," Lathrop noted.

The initiative was CMS' response to massive PWC fraud schemes that came to light in Houston, which is located in Harris County. Medicare paid more than 31,000 claims for power chairs in Texas in 2002 compared to 3,000 in 2001, officials said when Wheeler Dealer was launched.

The agency put the 10-point initiative into place in September 2003. Among other things, the plan suspended issuance of new provider numbers; required all payments for motorized wheelchairs in Harris County to be scrutinized and approved by CMS staff on a special task force; required the medical provider to see the patient before prescribing a wheelchair or scooter; and targeted power wheelchairs as the "first item analyzed for potential inherent reasonableness adjustments."

Harris County HME providers were also required to attend training programs on CMS medical policies.

While Lathrop said the current number of claims for power wheelchairs was not "readily available," she cited these statistics:

--Submitted charges in 2002, the year before Operation Wheeler Dealer went into effect, added up to $154,774,372; by Oct. 1, 2006, they had dropped to $20,150,712.
--The total number of beneficiaries (billed) also dropped dramatically, from 21,353 in 2002 to 3,354 in 2006.
--As of Feb. 26, 2004 (when the National Supplier Clearinghouse completed site visits in the area), supplier numbers for 355 Harris County companies had been revoked.

Lathrop added that "CMS definitely believes that Operation Wheeler Dealer was a success." She noted the initiative also gave the agency ammunition to fight fraud in other areas.

"There are a number of activities related to OWD that could be replicated elsewhere, if needed," she said. "These include targeted medical review; on-site visits to suppliers to identify non-existent or out-of-compliance suppliers; and training of suppliers and physicians on medical policies, claims submittal and requirements for the particular products/services."

For more on providers in Harris County, check the upcoming spring issue of HomeCareXtra.

Special Chocolate Could Delay Brain Decay (Or, Where's My Mars Bar?)
SAN FRANCISCO--Researchers at the annual meeting of the American Association for the Advancement of Science last month said a special type of cocoa could help maintain brain function and stave off cognitive decline and dementia as people age.

In a session called "The Neurobiology of Chocolate: A Mind-Altering Experience?," Ian Macdonald, a professor at the U.K.'s University of Nottingham Medical School, said a brain imaging study he conducted suggests that flavanols--a naturally occurring nutrient found in fresh cocoa--may improve blood vessel function, thus increasing brain blood flow and "enhancing brain function among older adults."

After study participants drank a flavanol-rich cocoa beverage from Mars Inc., their brains showed increased blood flow for a two-to-three-hour period, Macdonald said. He noted this raises the possibility that increased blood flow might benefit older adults and those who have cognitive impairments like fatigue or sleep deprivation.

In a separate U.S. study, Harvard Medical School researcher Norman Hollenberg said he observed a "striking blood flow response" that evolved over several weeks after healthy volunteers over age 50 were fed the special Mars cocoa.

Hollenberg said he found similar benefits in the Kuna Indians of Panama, who drink natural cocoa rich in flavanols on a daily basis. In addition to low rates of cardiovascular disease and cancer, there are no reports of dementia among the Kuna, he said.

While it's still too early to conclude that cocoa leads to better health, the scientists cautioned, more research is warranted.

Manufacturer News
Respironics Acquires Limb Activity Monitor
MURRYSVILLE, Pa.--Respironics has acquired the PAM-RL, an objective limb activity monitoring device, from IM Systems. Terms of the transaction were not disclosed.

The device is used to record and analyze periodic limb movements, which can disrupt sleep and are often associated with restless leg syndrome and other neurological disorders. The device gives researchers and clinicians a quantifiable method for assessing limb movements that can be applied in studying drugs and medical devices designed to treat RLS, the company said.

While typically worn around the ankle during sleep, the PAM-RL can record leg movements for more than five consecutive days. The data are then analyzed to determine the frequency of PLM events.

"The PAM-RL is the first tool to record PLMs outside of a sleep lab or clinical trial environment. Instead of subjects spending time in a lab, they are able to remain in the comfort of their own homes and go about their normal daily activities," said Dennis Dalangin, marketing manager. "This patient benefit, along with ease of use, low-cost and physician-friendly features--such as high resolution data and an up/down sensor--make the PAM-RL an effective alternative to expensive and cumbersome methods required by sleep labs."

According to Respironics, RLS affects up to 10 percent of the U.S. adult population. Symptoms include involuntary twitching or an overwhelming need to move the limbs; sensations described as crawling, creeping, tingling or pulling, especially at night; the inability to sit or lie still for extended periods of time; severe sleep deprivation; and relief associated with walking.

In 2004, Respironics formed a new business unit called Sleep Wellness Ventures to expand development in the problem sleep area and focus on sleep disorders outside of obstructive sleep apnea.

"We think there's a tremendous and growing opportunity," company President and CEO John Miclot said at the time. "We surveyed a group of [healthy] individuals, and over half of them said they suffered from sleep problems that affected their quality of life. So we believe half the population is a potential market opportunity."

Newsmakers
Wilkinson Moves to Inogen as VP of Product Management
SANTA BARBARA, Calif.--Scott Wilkinson has joined Inogen as vice president of product management, where he "will be instrumental in spearheading Inogen's expansion and influence beyond its core North American markets," the company said.

Prior to joining the manufacturer, Wilkinson served as group product manager for oxygen therapy at Elyria, Ohio-based Invacare Corp., where he was involved with the introduction of the HomeFill II oxygen system. He has also served as product line director at Johnson & Johnson for its orthopedic trauma line, and has held positions with Kimberly-Clark and Plast-O-Meric.

Wilkinson said his new position is "an opportunity to continue the crusade to improve the lives of oxygen therapy patients with innovative products that will drive the paradigm shift in the HME market."

Inogen debuted the Inogen One, which functions as both a stationary and portable oxygen concentrator, in 2003.

Former NATO Commander Joins Invacare Board
ELYRIA, Ohio--On Friday, Invacare Corp. announced that General James L. Jones, United States Marine Corps (ret.), who recently retired as Supreme Allied Commander of NATO (North Atlantic Treaty Organization) and Commander of the United States European Command, has joined its board of directors.

"As Invacare continues to increase its focus on global sourcing and sales, it will benefit greatly from General Jones' extensive international experience and from the leadership qualities he exhibited as Commandant of the Marine Corps, a position he held for four years prior to becoming NATO Supreme Allied Commander," Invacare Chairman and CEO Mal Mixon said in a statement.

According to the company, Jones will "be an active participant in the future strategic direction of Invacare's management, sales, marketing and sourcing plans on both a domestic and international front."

Jones, who is credited with developing NATO's global military capabilities, has a Bachelor of Science degree and an Honorary Doctorate from Georgetown University. He was commissioned into the Marine Corps in 1967 and served in Vietnam as a platoon and company commander. He graduated from the National War College in 1985 and later served as Military Assistant to the U.S. Secretary of Defense.

Keiderling Takes Reins at U.S. Rehab
WATERLOO, Iowa--Jerry Keiderling has been promoted to president of U.S. Rehab, The VGM Group's alliance for high-tech rehab providers.

Keiderling's career began in rehab sales and service with the former Miller Medical Service, which was founded by VGM CEO Van G. Miller in 1976. In his 12 years with VGM, he has worked in the wholesale division and in member services, and became vice president of U.S. Rehab in 1999.

During his tenure, U.S. Rehab has developed a rehab technician training program, Assistive Technology Supplier credentialing and now administers the Certified Environmental Access Consultant (CEAC) program.

Keiderling serves on the board of directors of the National Coalition for Assistive and Rehab Technology and the American Association for Homecare's Rehab and Assistive Technology Council.

In Brief
CMS has approved Cigna Government Services' plan to assume full operation of DME MAC Jurisdiction C on June 1, 2007, taking over claims processing for the 15-state region, Puerto Rico and the U.S. Virgin Islands from Palmetto GBA. Cigna has developed a special Web site for updates on its progress at www.cignagovernmentservices.com/transition. The site also includes an inquiry tool to allow providers and suppliers to submit questions online. Cigna said it will be issuing a series of implementation newsletters starting March 15 and will also conduct a series of Ask The Contractor teleconferences beginning this month.

Noridian Administrative Services said it has made "significant progress" in reducing its backlog of aged claims. In early January, the Jurisdiction D DME MAC had 104,803 claims over 31 days old, but Noridian said it has cut that number to 25,202 claims over 31 days old as of Feb. 28. Noridian also said it had decreased the number of days' work on hand, from 22 days in early January to 8.75.

CMS has posted a Medlearn Matters article on the Deficit Reduction Act's payment changes for maintenance and service of capped rental DME and oxygen. To download a PDF of the article, click here.

Medtrade goes "On the Road" in March. To keep providers updated on the industry's fast-changing landscape, Medtrade has developed a series of specialty mini-conferences that will address HME's hottest topics, including competitive bidding, reimbursement changes and more. These new On the Road educational conferences are coming to a city near you, so pick your topic and pick your date. There's still time to register for Medtrade's Reimbursement Conference March 23 and Medtrade's Competitive Bidding Conference March 27. For more information, visit Medtrade Conferences On the Road.