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Industry Notes:

CONGRESSMAN PROPOSES AXING FEHBP CUTS TO DME

Published on Thu Jun 10, 2004

Federal health plan's costs aren't the same as Medicare's.

Durable medical equipment suppliers are getting some lawmakers in their corner.

Rep. Dave Hobson (R-OH), along with Democratic co-sponsor Harold E. Ford, Jr. (TN), have introduced a bill calling for the repeal of the DME payment rate cuts down to Federal Employees Health Benefit Plan levels.

Last December's Medicare Modernization Act called for cuts to FEHBPpayment rate levels by 2005. Some of the cuts may be as high as 22 percent, the American Association for Homecare has estimated.

The FEHBP payment rates referenced in MMA, which would affect oxygen and oxygen equipment, wheelchairs, nebulizers, diabetes lancets and test strips, hospital beds and air mattresses, were contained in an HHS Office of Inspector General study that is very small in scope. And the costs and beneficiary population for FEHBPversus Medicare are very different. Thus, paring Medicare prices down to FEHBPlevels is unfair, critics say.

Bill proponents hope the legislation will gain cosponsors, showing congressional support for repealing the DME cuts. Then, the provision could be included at the end of the congressional session in a possible wrap-up bill containing many Medicare changes.

Observers expect the specific FEHBP cuts to be announced this summer.

  • More details about coverage for Diabetes Self Management Training are forthcoming in the new section on the topic in the Medicare Benefit Policy Manual. Certified providers of DSMT can include DME suppliers, the Centers for Medicare & Medicaid Services clarifies in May 28 Transmittal No. 13. The DME suppliers must bill Medicare for other services, obtain a provider number from the local carrier to bill DSMT, and must be accredited.

    Aregistered dietitian can't be the sole provider of DSMTservice, CMS also says.

  • CMS has added a listserv for DME, prosthetics and orthotics suppliers at long last. Suppliers interested in the Medicare DMEPOS provider listserv can sign up at www.cms.hhs.gov/mailinglists. CMS already has established a listserv for HHAs, also available through the Web site.

    "One of the key goals of the President's Electronic Government Initiative is to make it easier for citizens and providers to get services from their government," CMS Administrator Mark McClellan says in a release announcing the new listerv.

  • If you receive a rejection forcertain prosthetics due to skilled nursing facility consolidated billing, you can rebill and receive separate payment -- but only if you're paying attention.

    CMS accidentally left two new codes -- L5673 (Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism, effective January 1, 2004) and L5679 (Addition to lower extremity ... not for     use with locking mechanism, effective January 1, 2004) off the list of codes that can be paid separately from SNF bundling, the agency explains in May 29 Transmittal No. 191.

    The two L codes replaced codes K0557 and K0558 and were inadvertently left off the list allowing separate payment, CMS explains. The codes will be added Oct. 1, but suppliers will receive rejections for the items until then for patients under a Part ASNF stay.

    "Since these codes were mistakenly not added to the edits for services that are separately payable outside of consolidated billing and the PPS rate, the provider or supplier should not contact the SNF for payment of these claims," CMS instructs. Instead, suppliers should bring incorrectly rejected claims to the attention of the DME regional carrier or fiscal intermediary, which will then "re-open and re-process claims using the CWF override code," CMS says in the transmittal.

  • Hospices can download a newly revised training manual from regional home health intermediary Palmetto GBA's Web site, the RHHI says. The manual is available at www.palmettogba.com/palmetto/providers.nsf/(Docs)/85256D580043E754852566B1005E6196?OpenDocument.

  • NeighborCare Inc. has rejected a bidfrom Omnicare Inc. to buy the pharmaceutical, DME, respiratory and home infusion company, but it may not be the last heard of the deal. Covington, KY-based Omnicare, which furnishes drugs to long-term care facilities, offered to buy Baltimore-based NeighborCare for $30 a share -- about $1.5 billion, Omnicare says.

    Omnicare has a history of hostile takeovers, and NeighborCare could be next on its list, reports The Daily Deal.

  • Add one more hospital-based home health agency to the ranks of Amedisys Inc.

    The Baton Rouge, LA-based home health chain has acquired a Vicksburg, MS-based HHAfrom River Region Health System for undisclosed terms, the company says. Mississippi is a certificate-of-need state, which will limit competition to the acquisition, Amedisys says in a release.

    "We are excited to further expand our presence in the Mississippi market through this acquisition," says Amedisys CEO William F. Borne. The acquisition, which has a CON covering eight counties, should generate $2 million in annual revenues, the company says.

  • Arlington, TX-based Nursefinders Inc. has secured a contract with Baltimore-based disease management firm XLHealth to serve XLHealth patients enrolled in the Medicare DM demonstration project. Nursefinders will conduct comprehensive health assessments for 10,000 Texas patients, assist in coordinating patients'care, and furnish traditional home care services for the patients when required, the home care and staffing company says.

    Nursefinders will add new locations in Austin, Corpus Christi and Tyler, TX as a result of the contract, which will last throughout the three-year DM pilot. "Nursefinders'participation in this program will put our company and clinicians at the leading edge of disease state management and outcomes based care," Nursefinders chief nursing officer Pamela Wendt says in a release.

  • A chunk of the layoffs Matria Healthcare revealed in its last earnings report took place in Roanoke, VA. The company let 25 of its employees there go, reports The Roanoke Times.

    Marietta, GA-based Matria said it was having sagging profits (see Eli's HCW, Vol. XIII, No. 16). The Roanoke office is engaged in diabetes supplies sales, the paper says.

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