Moving the HME Industry Forward

Legislative/Advocacy

AAHomecare in Action – Report from the Northeast and More

February 2, 2015

LONG ISLAND, NY – Up and down the Northeast, HME providers spent much of the past week preparing their customers for the big snow storm and power outages in its aftermath.

Millions of Americans depend on home medical equipment that requires electricity such as oxygen concentrators, ventilators, and nebulizers. During disasters like blizzards, hurricanes, or heat waves, HME providers become first responders, working to ensure the safety of their homecare patients.

Continued Care on Long Island, NY, has been delivering equipment to their patients who have lost power or are in need of life supporting medical supplies. Employees have been coordinating care and service by phone, text and even Facebook to more than 500 patients who needed help in Nassau and Suffolk counties.

Unfortunately, due to the red tape of the Medicare competitive bidding program, Continued Care can no longer serve certain equipment to Medicare patients in competitive bid areas where other providers have been assigned contracts. This equipment includes wheelchairs, hospital beds and oxygen.

“For the first time in thirty years, we are unable to help Medicare patients during a state of emergency,” said Dan DeSimone, CEO of Continued Care. “Because of competitive bidding, only the bid winners for the area can service those Medicare patients. It’s really sad, because since those bid winners aren’t local, they can’t or won’t put the resources into getting through the blizzard in time to save people who are experiencing power outages and medical emergencies. Unfortunately, most of those patients have been forced in the past to go to the hospital because they can’t get their supplies. That’s why, as a local provider who has resources onsite, we are often asked by the local hospitals to set up oxygen concentrator stations in emergency rooms so that those patients have somewhere to go without readmission.”

Cape Medical Supply in Sandwich, Mass, was proud to work with their community partners to help residents. As featured in the Cape Cod Times, in a new step this year, the regional shelters were stocked with oxygen tanks courtesy of Cape Medical Supply. The stocking was part of the “lesson from Nemo” two years ago when elderly or infirm people left their tanks at home or ran out of oxygen while staying at the shelters during that storm.

“We worked with a cross section of local emergency management professionals to ensure life sustaining oxygen equipment was on hand in emergency shelters and were pleased officials recognized the needs these patients face during natural disasters, said Gary Sheehan (pictured during a presentation at last year’s Medtrade), president and CEO of Cape Medical Supply. “Coming together with a proactive plan allows first responders to focus on emergencies and provides patients with clear guidance on where they can go to keep warm, remain safe, and have access to medical oxygen throughout the event. We were proud to play a small part in what was ultimately a very well-coordinated and executed regional response to a significant weather event.”

OIG Report Summary: Medicare Power Mobility Device Claims
WASHINGTON, DC – In January 2015, the Office of Inspector General (OIG) of Department of Health and Human Services (HHS) released a report titled, “Medicare Paid Supplies For Power Mobility Device Claims That Did Not Meet Federal Requirements For Physicians’ Face-To-Face Examinations Of Beneficiares.”

The objective of this review was to determine whether Medicare paid power mobility device (PMD) claims in accordance with Federal requirements for face-to-face examinations of beneficiaries. In calendar year (CY) 2010, Medicare Part B paid durable medical equipment (DME) suppliers approximately $575.6 million for claims for PMDs. Previously, OIG found that a high percentage of PMD claims were unallowable and claims without corresponding Part B physician claims were at high risk of being unallowable.

In this report, OIG found that many PMD without corresponding G-code claims did not meet the federal requirements. Of the 100 sample claims, 53 claims met the requirements, but 47 did not.  The OIG estimates that Medicare overpaid by approximately $35.2 million in CY2010. OIG recommends CMS to:
1) adjust the 47 sample claims to the extent allowed under the law;
2) require physicians to use the G0372 code when prescribing PMDs;
3) require Part B Medicare contractors to educate physicians on the use of the G0372 code and the documentation requirements for face-to-face examinations;
4) and require DME Medicare contractors to match suppliers’ PMD claims to physicians’ G-code claims.

Click here to read the full summary from AAHomecare.