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Tuesday, June 25, 2019 @ 01:06 PM  posted by jbuytaert

Additional HCPCS Codes Added to Prior Authorization List

Thursday, April 25, 2019 @ 01:04 PM  posted by jbuytaert

courtesy of HomeCare Magazine
WASHINGTON, (April 18, 2019)T

The Centers for Medicare & Medicaid Services (CMS) has selected 12 additional items of Durable Medical Equipment (DME) to be subject to required prior authorization (CMS 6080-N2).

CMS is adding the following seven Healthcare Common Procedure Coding System (HCPCS) codes for power mobility devices (PMDs) to the Required Prior Authorization List: K0857, K0858, K0859, K0860, K0862, K0863 and KO864. Prior authorization for these PMDs will be implemented nationwide, beginning July 22, 2019.

CMS is adding the following five HCPCS codes for pressure reducing support surfaces (PRSS) to the Required Prior Authorization List: E0193, E0277, E0371, E0372 and E0373. Prior authorization for PRSSs will be implemented in two phases. Phase one will begin July 22, 2019. CMS will limit prior authorization to one state in each of the four DME MAC jurisdictions as follows: California, Indiana, New Jersey and North Carolina. Phase two will begin Oct. 21, 2019 and expands prior authorization of these codes to the remaining states and territories.

All HCPCS codes previously added to the Required Prior Authorization List will continue to be subject to the requirements of prior authorization.

In addition, CMS has provided the annual update to the master list of DMEPOS items that the Secretary determined, on the basis of prior payment experience, are frequently subject to unnecessary utilization (CMS 6078-N2). As noted in CMS 6050-F, the agency adjusts the payment threshold each year for inflation. This update adds the following four HCPCS codes to the master list because they meet the updated payment threshold and are listed in a CERT DME and/or DMEPOS Service Specific Report: E1390, E0466, E0784 and L0650.

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The April webinar Front Wheel Drive: Past, Present, and Future is this Friday April 12th. Register here!

Take the webinar and get an exclusive sneak peak of the all new 2019 F-Series, the power family of front wheel drive!

April 12th, 1:00pm – 2:00pm EST

Jennith Bernstein, PT, DPT, ATP/SMS
Regional Clinical Education Manager

Brandon Edmondson, OTR, ATP
Director of Clinical Sales and Outcomes BR Americas

Webinar Overview:

Drive wheel configuration is one of the many critical decisions one has to make when completing a power wheelchair evaluation. This Webinar will discuss the intended use of front wheel drive configurations, the impact that front wheel drive can have on functional mobility and the influence of drive wheel placement when completing MRADLs. We will also take a look at the history and intended use of the design as well as what is new in the ongoing development of the product with the launch of the Permobil F-Series for 2019.

Note: Since this entire webinar is discussing a specific product, according to CEU/CCU guidelines, no CEU/CCU education credits can be issued; however, a certificate of participation will be available for download.

People for Quality Care Launches Consumer Access Survey

Wednesday, April 3, 2019 @ 07:04 AM  posted by jbuytaert
Waterloo, Iowa – People for Quality Care launched a survey on April 1 asking end users of home medical equipment (HME) and supplies and family caregivers to evaluate the impact of Competitive Bidding on beneficiary access to care during the gap period of the program.

“Ensuring we understand the direct impact that Competitive Bidding is having on consumers and caregivers is critical in helping us communicate their issues to elected officials,” says Rob Duryea, director of People for Quality Care.

This survey is intended to help assess beneficiaries’ experiences obtaining HME supplies and services impacted by the Competitive Bidding program across former competitive bidding areas (CBAs), rural areas, and non‐bid, non‐rural areas. While primarily targeting Medicare beneficiaries, the survey is also open to those with other insurance who have been impacted by the ripple effect of the Medicare program. This nationwide survey will be open until Friday, April 26. Findings from the survey can aid in discussions with policy makers and shapers about the impact of the program and rates stemming from it.

Suppliers are encouraged to assist in raising awareness of the survey and share the survey link, available here, with their customers and local consumer groups.

“The 2016 Dobson DaVanzo patient access survey was an instrumental tool in uncovering some of the significant challenges that end users, case managers, and suppliers faced when Competitive Bidding expanded nationwide and helped pave the way for meaningful relief through the IFR and ESRD Final Rule,” recalled Ashley Plauché, legislative partner for People for Quality Care and manager of Government Affairs for AAHomecare.

“By adopting the basic principles of that survey into this new outreach effort,” Plauché explained, “we will get meaningful, current intel that highlights the real‐world impact this program is having during the gap period and beyond. This information is critical to legislators and regulatory bodies who are tasked with the responsibility of preserving beneficiary access to care under the Medicare benefit.”

“Our number one priority for conducting this survey is to hear from people who are struggling to get quality HME and supplies so that we can assist in sharing their story,” says Rose Schafhauser, state association partner for People for Quality Care and executive director of MAMES and SWMESA.

For more information, industry stakeholders may contact People for Quality Care by emailing or visiting the People for Quality Care website.

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Courtesy of American Association for Homecare – 3/20/19

CMS’ recent announcement that the Agency was moving forward with plans to add non-invasive ventilators to the product mix for the 2021 CB Round is of critical concern for respiratory suppliers, medical professionals, and patients and caregivers who rely on these products.

In the week-plus since CMS included that information as part of new details and a timeline for the next bidding round, I’ve heard from numerous leaders at respiratory companies, clinician groups, and organizations representing impacted patient populations.  Not surprisingly, everyone I’ve spoken with is highly motivated and prepared for an aggressive campaign to push back against this policy change.

For the larger HME community, this announcement is a fresh example of why we need to remain committed to building strong relationships on Capitol Hill and continuing to grow our industry’s advocacy capability.  It’s yet another reminder that policymakers at both Federal and state levels are certain to continue to look for new avenues to limit Medicare and Medicaid expenditures even as the populations served by these programs grow.

Despite this latest challenge, I am more positive than I have ever been about the HME community’s advocacy capability.  There is no question that the reimbursement relief and bidding program reforms gained through the CURES bill and the ESRD/DMEPOS Rule would have never taken shape without your strong grassroots advocacy for rural relief legislation over the last two Congressional sessions.  The wide support on multiple Congressional sign-on letters in support of these priorities is a direct reflection on the relationships you’ve built and the credibility you’ve established for HME on Capitol Hill.

Looking Ahead

We are currently working with our champions on Capitol Hill to develop legislation providing more substantial and longer-term relief for HME suppliers in non-bidding areas, and also in discussions with respiratory stakeholders and our patient group allies on a plan of action to address the ventilator issue.  Once again, the prospects for success on these issues will mainly rest on our ability to educate and engage hundreds of members of Congress that our policy priorities are critically needed by both HME suppliers and patients.  We’ll be counting on long-time HME advocates to continue to work with their legislators, and we’ll also need fresh faces to become involved in HME advocacy.
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