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  12/21/16
Oxygen Cuts
AAHomecare Pushes Back Against Additional Cuts for Stationary Oxygen
Yesterday, AAHomecare submitted a letter to the Office of General Counsel at HHS expressing concern about the 2017 Medicare fee schedule for stationary oxygen, which has resulted in rates for rural and other non-bid area suppliers that are lower than the competitive bidding rates for this product category than the rates in many CBAs. 

These new rates stem from the application of a 2006 budget neutrality offset balancing increased utilization for oxygen generating portable equipment (OPGE) with lower reimbursement for stationary equipment.  

In essence, CMS is cutting reimbursement rates twice for this product when the 2006 offset is combined with rate-setting data from the bidding program.  We’re disappointed – but sadly, not surprised – that CMS is once again trying to find a way to reimburse Medicare providers at the lowest rate possible, rather than employing a common-sense and sustainable pricing approach.

Our rationale for challenging these rates and asking for a recalculation based on the methodology for rural/non-bid rates set forth in 42 CFR §414.210 are detailed in our letter. 

You can view our letter and a comparison of the new rates vs. CBA rates here.
Power Mobility
Prior Authorization For Power Wheelchairs Moving Forward

On Monday, CMS announced that they will be phasing in two power wheelchair codes, K0856 and K0861 to the prior authorization program. Starting on March 20, 2017, CMS will implement prior authorization to one state in each of the DME MAC jurisdictions. The states participating in the first phase include: Illinois, Missouri, New York, and West Virginia. Starting July 17, 2017, prior authorization will be expanded to the rest of the states. CMS will issue a subregulatory guidance that will provide a more detailed explanation of the process. 

You can find the notice here.

2017 Rural and Non-bid Rates
January 2017 Pricing Analysis

AAHomecare has completed the pricing analysis of the new fee schedule that will take effect January 1, 2017. AAHomecare reviewed the top 25 HCPCS codes that are reflective of the industry and compared the rates against 2016 and 2015 fee schedules. The analysis is segmented by the 8 geographical regions, and prices used are the average of all the states within each region.  We found that overall, there will be a 36.8% decrease in reimbursement in 2017 compared to this year’s fee schedule for the top 25 items. Our analysis shows that E0277 (low air loss mattress) will experience the greatest price reduction in non-rural areas, averaging about 58% compared to this year’s reimbursement rate.

The chart below shows the analysis for E0277 in the 8 regions:

 

REGION 1/1/2016 REGIONAL RATE 1/1/2017 REGIONAL RATE 2017 v 2016 REGIONAL RATE
NEW ENGLAND $460.54 $183.15 -60.2%
SOUTHEAST $423.15 $196.44 -53.6%
PLAINS $458.08 $201.19 -56.1%
ROCKY MTN $462.05 $195.20 -57.8%
GREAT LAKES $449.45 $179.63 -60.0%
MIDEAST $427.99 $171.69 -59.9%
FAR WEST $437.74 $168.06 -61.6%
SOUTHWEST $447.02 $200.40 -55.2%


You can find the full January 2017 pricing analysis here

Industry News
Mediware to Serve on National Uniform Claim Committee for AAHomecare

Post-acute healthcare software provider Mediware Information Systems, Inc. will represent AAHomecare on the National Uniform Claim Committee (NUCC) for 2017. The NUCC comprises a diverse group of healthcare industry stakeholders working to help standardize data to transmit claims and encounter information to and from all third-party payers.  Mediware DME software product managers Rebecca Bowden and Kimberly Commito will serve on the Committee.

“We are pleased Mediware will serve on the NUCC, representing the HME industry on behalf of the AAHomecare,” said Tom Ryan, president and CEO of AAHomecare.  “The work of this voluntary organization, whose efforts to set standards for claims and electronic transmissions allows all providers to work more efficiently and be compensated for the services provided, makes a huge impact for providers. We thank Mediware for their willingness to participate in this committee and know from their involvement and commitment to AAHomecare that they will bring great technical expertise and comprehension, along with passion and zeal to the work they do with NUCC,” added Ryan.

See more information in Mediware’s press release.

Membership Survey
Reminder to Complete your Member Survey—Deadline Extended to December 22

If you have not done so, please complete and submit the 2016 Member Survey requesting feedback on the services, programs, and support provided this past year by AAHomecare. This information will let AAHomecare know how we have done this year, how we can do better, and what you would like to see from us going forward in 2017. We are a membership organization and here to meet the needs of this community, so please let us know how we can serve you better.

The primary contact for each organization received the link via email. We would like to limit responses to this survey to the one person at each company who is most familiar with AAHomecare and knowledgeable about our activities. If you did not receive the link but feel you would be the best person to complete the information, please contact Gina Conlon at ginac@aahomecare.org.

Council Update
Regulatory Council Meeting Highlights

On December 7-8, the Regulatory Council met for their final meeting of 2016. The Council discussed opportunities for regulatory changes in the new year and finalized their goals for 2017. A subgroup will be meeting in January to review potential opportunities to revise CB with the changes in the administration and HHS.  In addition, Kim Brandt from the Senate Finance Committee provided a legislative update to the Council and shared that passing a revised version of the AFIRM Act, the audit and appeals reform legislation, will be a top priority early next year. 

Stand Up for Homecare
Consider the Gift of Stand Up for Homecare Tickets this Christmas 

Support the industry public relations efforts and give someone (including yourself) the opportunity to network with industry leaders by purchasing a ticket to the Stand Up for Homecare reception at Medtrade Spring in Las Vegas on February 28 from 5:30-7:00 pm. This event celebrates and raises funds for the industry. The reception will take place in the Mandalay Bay South Seas Ballroom F.  Please visit aahomecare.org/standup for more information. 

With your help, we can tell millions more with the positive outcomes of homecare and the need for a permanent fix for detrimental policies affecting our industry in 2017.

Holiday Schedule
AAHomecare Off to Ring in the New Year
The AAHomecare offices will be closed Dec. 30 and Jan. 2 so our staff can ring in the New Year.  We wish you all a safe and enjoyable beginning to 2017!

While the AAHomecare offices will be open Tuesday through Thursday, Dec. 27-29, we will not be publishing Wednesday in Washington next week.
What's Happening
AAHomecare in Action
Tom Ryan, president & CEO, and Jay Witter, senior vice president of public affairs, along with VGM’s John Gallagher, met with Senate Finance Committee and House Ways & Means Committee staff… Kim Brummett, vice president of regulatory affairs, met with Orthotic Prosthetic Group of America and U.S. Rehab to discuss collaboration on the HME Audit Key initiative… the HME/RT Council, State Leaders Council, Respiratory work group, PMD Bundling work group, and High Tech work group convened… 
 
AAHomecare Corporate Partners

 
            
         
    

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