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Moving the HME Industry Forward

Billing/Reimbursement

  • Loan Closets - Delivery of Product
    March 27, 2017

    AMARILLO, TX - Recently, the following question arose: Under a consignment arrangement (commonly referred to as a “loan closet” or a “stock and bill” arrangement) between a DME supplier and a hospital, does Medicare require that a DME supplier employee go to the hospital to pull the product out of the inventory “closet” and hand it to the patient, or can a hospital employee access the product and give it to the patient? This article answers this question. read more »

  • HHS Won’t Meet Claims Backlog Deadline
    March 27, 2017

    WASHINGTON, DC - A March 7 Law360 article by Dani Kass confirms that the Department of Health and Human Services (HHS) will not be able to meet a court-imposed deadline to clear a backlog of Medicare billing appeals “unless it settles the claims without actually seeing if they have merit.” The statement came in a federal court earlier this month. read more »

  • The Anti-Kickback Statute and Arrangements Between Commonly-Owned Companies
    March 06, 2017

    AMARILLO, TX - The Medicare anti-kickback statute (“AKS”) makes it a felony to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a federal health care program. Under the guise of “you cannot kick back to yourself,” in order for the AKS to be violated, there needs to be two parties involved (e.g., Company A and Company B). read more »

  • ALJ Backlog Relief - HHS Appeals Court Ruling
    February 27, 2017

    AMARILLO, TX - In prior articles, I discussed a U.S. District Court ruling that ordered the Department of Health and Human Services ("HHS") to reduce the backlog of ALJ cases by 30% by the end of 2017, by 60% by the end of 2018, by 90% by the end of 2019, and entirely by the end of 2020. read more »

  • Paying Physicians - Guidance from Two Cases
    February 20, 2017

    AMARILLO, TX - Within certain legal parameters, a DME supplier can make payments to physicians. For example, if the supplier and physician enter into a legitimate Medical Director Agreement, then the supplier can make payments to the physician. Likewise, if a physician will provide bona fide education services for the supplier, then the supplier can pay fair market value (“FMV”) compensation to the physician. In entering into these types of arrangements with physicians, the DME supplier must avoid violating the Medicare anti-kickback statute (“AKS”) and the federal Stark physician self-referral statute (“Stark”). read more »

  • Clinical Study - Be Aware of Kickback Problems
    February 13, 2017

    AMARILLO, TX - It is important for DME suppliers to be aware that they live in the proverbial “glass house.” As part of this awareness, suppliers need to understand two metaphors that govern an analysis of whether an arrangement is legitimate, or if it is simply a disguised kickback: “you can put lipstick on a pig…but it is still a pig;” and “if it looks like a duck, walks like a duck, and quacks like a duck…then it is a duck.” read more »

  • HIPAAwise.com and ACU-Serve Bring Billing/Compliance Wisdom to Medtrade Spring
    February 13, 2017

    LAS VEGAS – HME providers looking for powerful technology to boost billing acumen and HIPAA compliance should check out Booth #735 at Medtrade Spring. Attendees will find 20-year-old ACU-Serve right alongside newcomer HIPAAwise.com. read more »

  • Optimize Brightree, Optimize Your Business Illuminates on Day One of Medtrade Spring (Feb 27)
    February 06, 2017

    LAS VEGAS – Medtrade Spring attendees who are looking to get a firm grip on all aspects of their business should consider attending the Optimize Brightree, Optimize Your Business workshop, scheduled for day one (Monday, Feb 27) of Medtrade Spring. The conference portion of Medtrade Spring is set for Feb 27 and 28, while the Expo Floor will be open Feb 28 and March 1. read more »

  • Competitive Bidding Round 2019
    February 06, 2017

    AMARILLO, TX - On January 31, 2017, CMS announced plans to consolidate all rounds and areas included in the Competitive Bidding Program (“Program”) into a single round of competition – Round 2019.  After the current Round 1 2017, Round 2 Recompete, and National Mail-Order competitions conclude on December 31, 2018, Round 2019 contracts will become effective on January 1, 2019 through December 31, 2021.  Round 2019 will include 141 CBAs and 11 product categories. read more »

  • Exhibitor Spotlight - Prometheus Group Offers Revenue Cycle Solutions and Much More
    January 23, 2017

    LAS VEGAS - Prometheus Group is on a mission to help HME providers prosper in a new era of value-based care. Medtrade Spring attendees looking to streamline their operations will get a chance to meet with the company’s representatives at Booth #1150 when the show floor opens on Feb 28 and March 1. Educational sessions at the Mandalay Bay Convention Center in Las Vegas start one day earlier on Monday, Feb 27. read more »