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Headline News
CMS Launches Competitive Bidding Web Site
BALTIMORE--In anticipation of the final rule regarding national competitive bidding, CMS introduced its DMEPOS Competitive Bidding Implementation Contractor Web site last week.

Administered by Palmetto GBA, the designated CBIC, the Web site is available at www.dmecompetitivebid.com.

Most of the pages are under construction pending issuance of the final rule, but once completed, providers will be able to access information on the bid application process, the cities in which competitive bidding is active, educational tools and accreditation requirements, among a host of other topics.

As the CBIC, Palmetto will perform a variety of functions, including preparing the request for bids, evaluating the bids, helping to monitor the program's effectiveness and quality and sponsoring education programs for beneficiaries, suppliers and referral sources. The Web site will include the most up-to-date information on the competitive bidding project, according to CMS.

In its announcement about the Web site, CMS reiterated that all suppliers must provide current information to the National Supplier Clearinghouse in preparation for competitive bidding, noting that providers will have to be "authenticated" before submitting a bid:

"To ensure the safety and security of all suppliers interested in participating in the competitive bidding program, all suppliers will have to be authenticated before [they] will be able to submit a bid. It is imperative that all information you have provided to the National Supplier Clearinghouse is up-to-date for successful authentication to occur," the announcement said.

Providers who have not updated their information or who are unsure if their information is correct should contact the NSC, CMS advised.

The announcement also said that "CMS has not set a deadline for DMEPOS suppliers to become accredited in order to retain/obtain a supplier enrollment number or to competitively bid." But the agency also included a download of its 10 "deemed" accrediting organizations.

In addition, the CMS announcement pointed out five objectives for NCB:

1) To operationalize competitive bidding for DME and to use this to determine appropriate prices for categories of DME covered by Medicare Part B;

2) To protect beneficiary access to quality DME throughout the program;

3) To reduce the amount Medicare pays for DMEPOS and bring the reimbursement amount more in line with that of a competitive market;

4) To limit the burden on beneficiaries by reducing their out-of-pocket expenses; and

5) To mitigate proliferation of use of certain items of DMEPOS by contracting with suppliers who engage in a business model that is beneficial for the program and for Medicare beneficiaries.

For months, providers have been on pins and needles awaiting the final rule for NCB and the list of the first 10 metropolitan statistical areas in which it will be inaugurated. Industry insiders project that it could be released on Friday, and also expect a joint announcement will reveal the initial cities at that time.

To read the CBIC Web site announcement in full and access a download of CMS' 10 approved accrediting organizations, click here.

TriCenturion also noted that a decision on the pay rates for levalbuterol and DuoNeb has been deferred pending results of a national coverage analysis. The draft local coverage determination proposed paying for levalbuterol at rates comparable to albuterol and for DuoNeb at rates comparable to individual unit dose vials of albuterol and ipratropium. But CMS initiated a national coverage analysis on nebulized beta adrenergic agonist therapy for lung disease, prompting the deferment, TriCenturion said.

Another Revision to PMD Fee Schedule
BALTIMORE--In the latest of a series of revisions to its power mobility device fee schedule, last week CMS issued additional changes as part of its April 2007 quarterly update.

Effective for claims with dates of service on or after Jan. 1, 2007, payments have been revised for HCPCS codes K0822, K0825, K0835, K0838, K0848, K0850, K0851 and K0859.

While some payments went up--reimbursement for the K0825 Group 2 power wheelchair increased to $4,433.20--others went down. CMS said the adjustments reflect policy changes related to angle adjustable footplates, which are now separately billable for certain PMDs.

In addition, 2006 fee schedule amounts have been revised for HCPCS codes K0825, K0850, K0851 and K0859 for claims with dates of service from Nov. 15 through Dec. 31, 2006.

Beginning April 2, 2007, suppliers may submit previously processed claims for these items to the DME MACs or DMERCs for adjustment. The claims should not be submitted before April 2 in order to allow carrier system updates, according to CMS.

For specific coding questions, CMS advised contacting the SADMERC at www.palmettogba.com/SADMERC or calling (877) 735-1326.

"This is an opportunity," he said, adding that this is one instance for beleaguered providers where "there is light at the end of the tunnel and it's not a train."

Providers Look to Build Sales in HME Retail
ATLANTA--In larger numbers than ever reported, home medical equipment providers participating in HomeCare's 2007 Retail Survey said they intend to increase their retail sales this year. That's a big jump from the 58 percent of providers who said they were interested in doing more retail business in 2003, the last year the magazine's survey was conducted.

Overall, retail sales average only 14 percent of these providers' revenues, but many said they are looking to retail to replace revenues lost to recent Medicare reimbursement cuts and the anticipated effects of national competitive bidding.

The survey numbers reflect another shift the majority of providers reported: 68 percent find their customers are willing to pay out-of-pocket for the equipment and products they need. And 51 percent said they have seen increased business from walk-in retail customers over the past year.

Recognition that this retail gap is there to be filled--and that it's growing--is fueling plans for many of the home care companies in the survey group.

--As a whole, providers said they are doing more advertising in the retail area. Sixty-one percent said they currently advertise/promote their retail products, and about half said they now participate in vendors' co-op advertising programs. Those that do overwhelmingly said these programs are helpful, but also said they would advertise on their own without any help from vendors.

--One-third have expanded or remodeled an existing showroom within the past three years, while a quarter have added a new location with a retail showroom. Forty-four percent said they are considering remodeling/expansion plans.

--Twenty-two percent said they now change their showroom displays whenever new products come in. That number also has increased dramatically, up from only 13 percent in 2003.

--Significantly more current respondents also track revenue separately for retail customers vs. medical referral customers than did in 2003, 55 percent vs. 30 percent.

In one side note, 67 percent of the providers in the survey group as a whole said they intend to participate in competitive bidding. But, of the surveyed companies with revenues under $1 million, only 43 percent indicated they plan to bid.

To gauge your retail business against that of other providers, see HomeCare's 2007 Retail Survey in the March issue, available online at http://homecaremag.com/mag/medical_retail_survey/.

State News
Seven Florida Respiratory Care Workers Arrested
TALLAHASSEE, Fla.--Seven employees of a Holmes Beach, Fla., provider specializing in respiratory care for children have been arrested on charges of defrauding the state Medicaid program of nearly $2.7 million.

From November 2003 to December 2006, Acute Care Team allegedly submitted 39,551 fraudulent claims totaling $2,680,473, according to investigators with the Medicaid Fraud Control Unit.

Late last month, agents arrested four top company officers of Acute Care Team, including: Jeanne April Ferguson, 55, president; Nancy Wood, 53, chief financial officer; Cynthia Lee May, 52, chief operating officer; and Heidi Rickert, 48, office manager. They also arrested three respiratory therapists: Andrea K. Suarez, 36, supervising respiratory therapist; Carla J. Camacho, 42; and Stephanie L. Nichols, 34.

Each woman was charged with one count of Medicaid fraud, a third-degree felony, and one count of organized fraud, a first-degree felony. If convicted of both counts, each of the seven women faces up to 30 years in prison and fines of $15,000, authorities said.

The fraud control unit began investigating Acute Care last April after receiving information from the Agency for Health Care Administration, which oversees the Florida Medicaid program.

According to investigators, the women participated in a scam that involved submitting "substantial billing claims" that could not be verified by the patients' parents. Acute Care Team frequently claimed it provided care to patients several times a week, but parents of the children told investigators they only visited the facility once or twice and for much shorter times than the company claimed.

In one instance, Camacho reported seeing a 6-year-old 395 times in a three-year period. The mother, however, could not recall when an Acute Care Team employee last saw her child, investigators said.

Investigators also reported that other Acute Care Team staff members said they had been pressured to submit claims for patients they never treated.

No trial date has been set.

New Jersey Governor Takes Aim at Medicaid Fraud
TRENTON, N.J.--In an effort to coordinate Medicaid fraud-fighting activities, New Jersey Gov. Jon S. Corzine has signed a bill that create an independent office focused on prevention, detection and investigation of fraud and abuse.

The Office of Medicaid Inspector General will also be responsible for quality review, compliance, audits and information technology oversights that relate to Medicaid fraud and abuse. An attorney appointed to a five-year term by the governor and approved by the state Senate will oversee the office, which will be funded by a $3 million annual appropriation and 25 percent of the funds that it recovers. The latter funds will be shared with the Attorney General's Medicaid Fraud Control Unit.

The Medicaid Inspector General has not yet been named.

AARP Confirms New Yorkers Prefer Home Care
ALBANY, N.Y.--An AARP report on long-term care has found that the majority of people over 50 in New York State are worried they won't be able to afford long-term care for themselves or their families. The report also said home care is the most desired type of long-term care service for almost 80 percent of older New Yorkers.

Report findings include the following:

--60 percent of New York residents over the age of 50 are worried about their ability to afford long-term care services.
--40 percent said they will be in need of long-term care services for themselves or family members in the next five years.
--91 percent want a central place to obtain information on types of long-term care services.
--88 percent want lawmakers to increase funding for home- and community-based care.

"New York State needs to create long-term care that puts the patients' needs up front and that is quality long-term care services delivered in the home and not in an institution," said Lois Aronstein, AARP New York State Director.

AARP said it has more than 2.6 million members in New York State.

Ohio Governor Releases Funds for In-Home Care, HME
COLUMBUS, Ohio--Gov. Ted Strickland has issued an executive order releasing $3 million for a program that helps seniors receive care, including medical equipment, in their homes, according to a report in the Marietta Times.

The funds will eliminate a wait list of 1,500 elderly for the state's Passport Medicaid Waiver Program, which gives in-home assistance to help keep seniors out of nursing homes. In addition to releasing the funds for 2007, the governor said his state budget proposal would include $123 million for the program in 2008 and $148 million for 2009.

Free to seniors who meet income guidelines, the Passport program provides medical equipment and supplies, personal care, home-delivered meals, adult day care and emergency response.

Betsy Silk, a registered nurse and case manager for Passport clients, told the newspaper that Passport can provide services for less than $20,000--about a third of the average cost of keeping someone in a nursing home, which she said was $60,000 a year.

In Brief
An analysis by the congressional Joint Commission on Taxation found that President Bush's health care reform plan would increase taxes by $333.6 billion from 2009 to 2017, with 58 million Americans' taxes going up by an average of $2,295 per year. While the White House has said the plan, which would make health benefits over a certain threshold taxable, would level the playing field between employer-provided health insurance and that bought by those in the individual health insurance market, critics say it would leave many older and sicker Americans unable to find coverage. The analysis is available at http://www.house.gov/jct/x-17-07.pdf.

A study by the Robert Wood Johnson Medical School and Cincinnati Children's Hospital Medical Center published in the March issue of Archives of Pediatrics & Adolescent Medicine said bariatric surgery among teens in the U.S. tripled from just over 200 procedures in 2000 to almost 800 procedures in 2003. According to Randall Burd, a pediatric surgeon and the study's senior author, the trend, which parallels adult bariatric surgery, "suggests that the health benefits of bariatric surgery, including reducing the patient's diabetes, sleep apnea and heart disease, for example, are increasingly being recognized by patients and both adult and pediatric health care providers nationwide."

Harmony Pharmacy and Health Center is opening a mini-clinic and pharmacy in a concourse at New Jersey's Newark Liberty International Airport, the New York Times reported. The health center, staffed by a nurse-practitioner who can write prescriptions, will serve both airport passengers and employees. Harmony intends to put its mini-clinics in 15 major airports.