Budget neutrality dampens certain oxygen reimbursement | HME News
“These additional cuts for home oxygen therapy are certain to impact providers and patients in rural and other non-CBA areas,” stated AAHomecare in a bulletin. “Since CMS has repeatedly made it clear that they do not believe they have the statutory authority to address the budget neutrality offset, the HME community needs to make this a priority for advocacy efforts in the 116th Congress.”
“The purpose of the retail awards competition is to promote and recognize products that contribute to providers’ bottom lines though cash sales. Representatives from seven companies made their case to session attendees, who along with judges, voted on their top three choices.”
“Amazon is striving to make the patient’s access to medical supplies easier and comfortable with the help of this project. Notably, this project will allow the doctors to prescribe medical products necessary for their patients after a surgery or in general cases through the hospital’s online portal.”
“The report found: For 72% of inappropriate claims, DME suppliers failed to correctly code the SNF as a facility. Instead, they coded the place of service as the beneficiary’s home, thus enabling the claims to bypass the edit that rejects separate payment for most DME provided at facilities. By definition, SNFs provide primarily skilled care and thus cannot be considered beneficiary homes.”
The Sherman Food, Drug, and Cosmetic Law, among other things, prohibits a person from conducting a home medical device retail facility business in the state without a valid license from the State Department of Public Health. Existing law requires the department to inspect each place of business prior to issuing a license, and further requires the department to inspect each licensee at least annually.
This bill would modify, until January 1, 2023, the requirement for the department to inspect a licensed home medical device retail facility business if it is accredited, as specified, by an accreditation organization approved by the federal Centers for Medicare and Medicaid Services. If so accredited, the bill would authorize the department to conduct an inspection only upon a complaint made to the department regarding the licensee. For a licensee that is not so accredited, the bill would continue to require the department to conduct an inspection at least annually.
Section 4040.5 of the Business and Professions Code is amended to read:
4040.5. “Reverse distributor” means every person who acts as an agent for pharmacies, drug wholesalers, third-party logistics providers, manufacturers, and other entities by receiving, inventorying, warehousing, and managing the disposition of outdated or nonsaleable dangerous drugs or dangerous devices.
Section 4022.6 is added to the Business and Professions Code, to read:
4022.6. “Designated representative-reverse distributor” means an individual to whom a license has been granted pursuant to Section 4053.2, who is responsible for supervision over a licensed wholesaler that only acts as a reverse distributor. A pharmacist fulfilling the duties of Section 4053.2 shall not be required to obtain a license as a designated representative-reverse distributor.
“Another data point shows just how greatly Medicare’s importance as a revenue driver for HME has dropped. In addition to Medicare’s 16 percent share, Medicaid accounted for 15 percent of HME spending, and all other sources, such as private payer and retail sales, represented 68 percent of HME spending.”
“According to research AAHomecare had been performing using Medicare data, the number of traditional suppliers of home medical equipment to Medicare beneficiaries has dropped 40.9 percent since July 2013. In addition, the number of unique locations (commonly referred to as rooftops) serving Medicare beneficiaries has declined by 38.7 percent during the same period.”