PECOS Survey – Please Participate!
Respond by Friday, February 5
State Associations are working together through the American Association for Homecare’s State Leaders Council to gather information to share with CMS regarding PECOS edit warnings. The Council has created a survey with a brief explanation asking HME companies to provide the percentage of claims with the edit warning (PECOS). This survey was originally developed by the Region A Council but has been expanded nationwide. Please go to: http://www.surveymonkey.com/s/L28VX9J for the survey and complete by close of business Friday, Feb. 5.
Taxpayers’ Tea Party
Georgia State Representative Sharon Cooper (R-Marietta), Chairman of the House Committee on Health & Human Services, tells citizens to “Get Active!”. In fact, she’s written a book telling us how to do this, explaining how to start with a grassroots movement. Cooper gives advice on how to write an effective letter to your Congressman, the newspaper—even the President himself. CLICK HERE to order your copy. Let’s put her advice to work – to save homecare!
Update on Medicaid transition from ACS to HP Enterprise: From the GAMES Winter Meeting
by Weesie Walker, GAMES Board Member
For those of you who were not able to make the meeting on Tuesday to hear Gia Compton, I have prepared a summary of the information.
The presentation was done by Maryann Williams of HP Enterprise (formerly known as EDS).
She brought us up to date on the upcoming transition from ACS to HP that will occur on July 1, 2010. (Many of you will remember the transition from EDS to ACS and how much fun that was!)
Right now they are working on “User Acceptance Testing”. The implementation phase will begin in March. This consists of beta testing by providers in April and May. They are looking for volunteers to sign up to come to their office in Tucker and try out the system. Providers who volunteer will be placed on a list to be reviewed by DCH. They want a variety of providers to test the system and give feedback.
To volunteer for the testing, send an email to mary-ann.barndt-williams@hp.com
Other points of interest:
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ACS last cycle will be June 25, 2010
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Last electronic claim filing date is June 25 2010
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ACS last day to take phone calls June 30, 2010
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HP first claim cycle is July 2, 2010
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Electronic billing begins on June 28, 2010
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Paper claims can be submitted on June 21, 2010
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The web portal will look different, but have the same functionality
Within the next two weeks, HP hopes to have an unsecured web portal available to providers to all access to manuals and web trainingMedicaid beneficiaries will be issued new cards, For those members who still have the old card, the ID numbers are the same.
Providers should inform members that they need to seek new cards.
Invitations will be issued to providers for training workshops in February and March. The workshops will be held in April, May and June
WinASAP software will no longer be used. The new software for billing can be downloaded from the unsecured web site.
Providers will receive letters in June with new passwords for the web portal.
For customer service: Member call center 866-211-0950
Provider call center 800-766-4466
Call centers are open 7am to 7pm Monday thru Friday
Payment cycles are to remain the same.
Lobbying: Bill Cheek takes 'that extra step'
MONROE, Ga. - Provider Bill Cheek has been working in the HME industry for 16 years, but he'll be visiting Capitol Hill for the first time next month. What's driving him there: H.R. 3790, a bill that would eliminate national ... read more..
GAMES President Todd Tyson does it again!
When it comes to the unsafe Medicare Bidding program, Tyson is talking. All GAMES members are encouraged to do the same!! Please send examples of your successes to GAMES to be shared with other members.
CLICK HERE and check out pages 16 and 28.
Don't Miss VGM's Billing and Reimbursement Road Show coming to Atlanta on February 11!
 Presented by Peggy Walker, RN, Reimbursement Adviser - US Rehab
Billing and Reimbursement Road Show is a hands-on workshop that takes you through the Medicare billing process from start to finish. We will discuss basic billing rules for all DME, as well as how to work through a denied claim. We will review the effective use of ABNs, how to bill for repairs, and the proper documentation requirements for Mobility Assist Equipment. Fraud and abuse issues and current medical policy updates will be discussed. This seminar is appropriate for all experience levels, novice to advanced.
GAMES Members register at the VGM Member rate. When you register, be sure to indicate you are a GAMES member. VGM will send $15 per GAMES member that registers to GAMES!
CLICK HERE for the registration flyer.
Ron Morelli lost 192 pounds on The Biggest Loser 
Weighing in at an initial 420 pounds, Ron participated in the show with his son, Michael, 18, who lost 207 pounds and was the youngest finalist in the show’s history. Morelli, 55, of South Lyon, Mich. battled with his weight his entire life.
Hear his life-changing story, including the important role of home medical equipment, at the GAMES Spring meeting in Macon, GA on April 27, 2010.
Mark your calendar now! Meeting and Exhibit registration information is coming soon!
You can reserve your sleeping room at the Macon City Center Marriott for $109 by calling 800-228-9290 or locally 478-621-5300. Be sure to say you are with the Georgia Association of Medical Equipment Suppliers (GAMES) to get the discounted rate.
Gentiva(R) Health Services Sells Respiratory/HME and Infusion Businesses
ATLANTA, Feb 04, 2010 /PRNewswire via COMTEX News Network/ -- Gentiva Health Services, Inc. (Nasdaq: GTIV), a leading provider of comprehensive home health services, announced today that it has sold its businesses providing respiratory therapy and home medical equipment, and infusion therapy to a subsidiary of Lincare Holdings Inc. (Nasdaq: LNCR) in an all-cash transaction. Terms were not disclosed.
Read more…
Searchable PECOS Database now Available to DME Suppliers
By: Andrea Stark, MiraVista LLC
Suppliers now have a way to compare their referral sources against a list of those registered in the PECOS database!
With the issuance of CR6421, CMS promised to provide DME suppliers with a searchable database of PECOS enrolled physician and non-physician practitioners prior to the implementation of rejections on April 5, 2010. On January 28, 2010 CMS made good on their promise in the form of a 13,653 page .pdf (Adobe Acrobat) file, containing the NPIs, first and last names of all Medicare eligible referral sources currently enrolled in PECOS. The file is 16.63 MB in size and includes approximately 800,000 physician and non-physician practitioner records sorted by last name.
DME suppliers may download the file here:
http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/OrderingReferringReport.pdf.
Due to the size of the file, download times may range anywhere from 42 seconds to 42+ minutes, depending on the speed of your internet connection. For us, it took approximately 1.5 minutes. Once your download is complete, be sure to save the file to a specific location on your computer, so you don’t have to re-download later.
The good news, is that suppliers who download the file will now have a way to verify whether or not their ordering physicians are enrolled in PECOS. Using the search (Ctrl+F) feature, suppliers may look-up the NPIs of referring physicians and verify the correct spelling of their first and last names, as listed in the PECOS database. The bad news, is that since the file is in a .pdf format, there is no easy way to narrow down, filter, or otherwise sort through the nearly 800,000 records.
Suppliers should keep in mind that the list is a work in progress and will be updated/replaced on a monthly basis. Also, because of the time it takes contractors to review a physician's PECOS enrollment application (typically 45-60 days), newly enrolling physicians may not be included in the searchable list until two or even three months after they submit their application.
Georgia Medicaid reprocessing begins February 5th!
On Tuesday, 12/29/09, GA Medicaid posted a Banner Message to the GHP Web Site, announcing the dreaded reprocessing of DME claims from July 2009. According to their message, mass reprocessing will occur during the Feb 5 and Feb 12 claim cycles, to correct the new rates that were effective 7/1/2009, but were unable to be implemented until Oct. 1, 2009. This reprocessing has been delayed several times in the past, but appears to be on-track now.
Read more...
 Understanding DME and the Healthcare Reform Debate: Reprinted from VGM’s Legislative Update – February 1, 2010
As Democratic leadership in Congress debates a course of action for health care reform, it is imperative that DMEs understand the ramifications of the debate to take place over the next few weeks. Democrats in the House are now forced to consider a variety of options. The liberal/progressive side of the party fears time is not on their side, and is pushing to pass the Senate Bill followed by a separate bill through a process called Reconciliation, which would be designed to ‘correct’ areas where they feel changes are warranted. The moderate/Blue Dog portion of the party has raised concerns about the mood of the country toward health care reform, and is strongly opposed to the idea of passing the Senate version. Moderates have voiced their desire to go back to the drawing board and consider a bill that carries broad bipartisan support. While the coming weeks will determine which direction the House will go, DME operations are strongly encouraged to voice their opposition to the Senate package, which includes several detrimental DME provision. Contact your Senators and Representative today and stress that they not support the Senate Bill. The country has begged that the immediate focus be shifted to slowing unemployment and creating jobs, and our legislators have agreed to respond. Make them understand that this bill, along with competitive bidding, will cost the DME industry thousands of jobs over the next several years.
Key DME provisions from Senate legislation passed December 24, 2009:
Sec. 3136. Revision of payment for power-driven wheelchairs.
Eliminates the option for Medicare to purchase power-driven wheelchairs with a lump-sum payment at the time the chair is supplied. Medicare would continue to make the same payments for power-driven chairs over a 13-month period. Purchase option for complex rehabilitative power wheelchairs would be maintained.
Sec. 9009. Imposition of annual fee on medical device manufacturers and importers.
Imposes an annual flat fee of $2 billion on the medical device manufacturing sector beginning in 2010. This non-deductible fee would be allocated across the industry according to market share and would not apply to companies with sales of medical devices in the U.S. of $5 million or less. The fee does not apply to any sale of a Class I product or any sale of a Class II product that is primarily sold to consumers at retail for not more than $100 per unit (under the FDA product classification system).
Sec. 6410. Adjustments to the Medicare durable medical equipment, prosthetics, orthotics, and supplies competitive acquisition program.
Requires the Secretary to expand the number of areas to be included in round two of the competitive bidding program from 79 of the largest metropolitan statistical areas (MSAs) to 100 of the largest MSAs, and to use competitively bid prices in all areas by 2016.
Sec. 6411. Expansion of the Recovery Audit Contractor (RAC) program. Requires States to establish contracts with one or more Recovery Audit Contractors (RACs).
Sec. 6405. Physicians who order items or services required to be Medicare enrolled physicians or eligible professionals.
Sec. 6407. Face-to-face encounter with patient required before physicians may certify eligibility for home health services or durable medical equipment under Medicare.
Sec. 6401. Provider screening and other enrollment requirements under Medicare, Medicaid, and CHIP.
Sec. 6402. Enhanced Medicare and Medicaid program integrity provisions.
From NAIMES, February 1, 2010: President's Budget Leaves DME Alone
Mr. Obama's budget for FY 2011 was released today and contained no proposed cuts to DME. There were fears that the proposed budget would take a swipe at DME and possibly reduce the payments for oxygen by reducing the cap from 36-months to a shorter period. The 192 page Budget had no mention of DME or oxygen.
This takes the stress off DME in the short-term while we wait and see what, if any, healthcare reform bills will be advanced. The industry is still vulnerable to the many proposals in the House and Senate bills, which seem to be dead for now. The industry cannot afford to rest too much and must continue to monitor the healthcare reform debate to insure that unfavorable provisions are not moved forward. Of particular interest is the proposed fees on device manufacturers. These provisions will be extremely harmful to the DME industry, jobs, and small businesses.
NHOPA and AARC Announce Full Support of H.R. 3790
NHOPA and AARC announce their full support of H.R. 3790, legislation that would repeal competitive bidding for durable medical equipment under the Medicare program. You may utilize the following letters from NHOPA and AARC in your discussions with your legislative offices to gain support for H.R. 3790:
NHOPA Letter
AARC Letter
Strategies for Handling Complaints Teleconference 
Thursday February 25
11:30 AM to 12:30 PM ET with the industry's leading speaker and trainer
Louis Feuer, MA, MSW
Bringing You Advice That Will Save You Customers and Money
$99 per phone line - Train an entire company for one low registration.
Competitive times, new reimbursement issues and the increased costs of reaching and keeping new customers, makes making sure we never lose a customer a priority. Complaints can be devastating to your business. Rarely does a problem or mistake happen just once. Although we may have only heard about the problem once, it probably has happened before.
Register at www.DynamicSeminars.com or call a DSC Representative at 954-838-7504.
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