Congressman Jim Matheson visits UTMED to discuss Competitive Bidding and Audit Woes

Left to right: Kurt Walker, Tom Dye, Congressman Jim Matheson, Jay Broadbent, Brent Gardner

On Tuesday this week, UTMED arranged for a visit from Congressman Jim Matheson to meet with members of the UTMED Board. UTMED Vice President Jay Broadbent from Alpine Home Medical and board members Kurt Walker from Mountain Valley Home Medical and Tom Dye from Oxygen-for-You were in attendance. Congressman Matheson has been very supportive of UTMED in signing on as a cosponsor of HR 1041 and clearly sees competitive bidding as ineffective as a cost saving tactic by the congress. He was also very interested in receiving examples from UTMED members of unreasonable audit requirements such as refusal to pay due to physician signatures outside the lines, etc. As a result, he is going to seek hearings on CMS audit practices and will use the examples to disclose their burdens on local DME companies.

Article written by Brent Gardner, Executive Director of UTMED

AAHomecare Supports Key Anti-Fraud Bill Introduced in House

Friday, November 11, 2011

The American Association for Homecare (AAHomecare) is pleased that Representative Peter Roskam (R-Ill.) introduced an important bill yesterday designed to reduce fraud and improper payments in Medicare.

The Fighting Fraud and Abuse to Save Taxpayer Dollars Act, or FAST Act, H.R. 3399, would strengthen Medicare by shifting Medicare's "pay-and-chase" payment system to one that is modeled after credit card industry fraud-prevention tactics, utilizing predictive modeling technology to prevent paying fraudulent Medicare claims. The legislation also contains a provision, supported by AAHomecare, which would require an electronic prior authorization process for standard power wheelchairs in Medicare. This provision requires physicians to use a clinical medical necessity template to document the medical need for a power wheelchair. The Association believes that this physician template is a critical tool needed to reduce improper payments due to documentation errors.

AAHomecare has long fought against Medicare fraud. The Association has worked with Congress and the Administration to implement a number of key components of its 13 point anti-fraud plan. Visit www.aahomecare.org/stopfraud to see the plan. Last year, AAHomecare supported H.R. 5546, introduced by Rep. Roskam, which would have improved the tools and resources available to prevent fraud and abuse in Medicare through the use of predictive modeling technologies.

The Association welcomes the opportunity to work with Rep. Roskam on this important bill as it moves through the legislative process.

Article written by AAHomecare.

CMS defines durability, industry awaits CBO score

CMS defines durability, industry awaits CBO score

By Theresa Flaherty, Managing Editor - 11.04.2011

WASHINGTON - CMS last week issued final rules related to durable medical equipment, including a finalized definition of "durability." CMS originally proposed the defining "durability" as meeting a three-year minimum lifetime standard in the July 8 Federal Register. At the time, stakeholders said they were unsure of what CMS sought to accomplish. They're still unsure. "We're still trying to sort it out," said Jay Witter, senior director of government relations for AAHomecare. "The proposed rule was kind of vague, so our manufacturers didn't understand how it would affect their equipment." Initial concerns included whether redesigned equipment--saying improving the technology on an existing wheelchair--meant that it would have to meet the new criteria, and what the process for meeting that criteria is. "It's still not clear what the process is," said Witter, who was still analyzing the rule last week. The other rule finalized provisions related to competitive bidding that were included in an interim final rule released in January 2009, and the Medicare Improvements to Patients and Providers Act of 2008. "They tied up some loose ends, but there was no new policy," said Cara Bachenheimer, senior vice president of government affairs for Invacare. "The more disconcerting thing was that CMS used it as another opportunity to talk about how great Round 1 was." Meanwhile, the industry continues to build consensus for a market pricing program (MPP) as an alternative to competitive bidding. "We're trying to get it scored by the Congressional Budget Office," said Tyler Wilson, AAHomecare's president and CEO. "Then we'll know whether we've met the $20 billion in savings, or whether we need to find some additional savings. There's a lot at play and we have limited opportunity for conversations (with lawmakers)." Concerns have been raised that pushing forward with MPP would mean throwing Round 1 providers under the proverbial bus. While no one wants to see that happen, lawmakers have said they won't support MPP if it includes changes to Round 1. "It is a political reality that we can't get everything we want," said Wayne Stanfield, executive director of NAIMES. "Sometimes its prudent not to fight for everything, but take what you can get, with hopes of changing the impact on Round 1 afterward." Sean Schwinghammer, president of the Florida Association of Home Care Suppliers has said he's disappointed that the industry is moving forward without any relief for Round 1, but says he is supportive of MPP. "We are united in MPP and think it's a good idea for Round 2," he said. "But, to be clear, its ludicrous to use Round 1 as the justification for altering Round 2, and leaving Round 1 to exists." Article written by HME News.