Wondering what changes are in store for respiratory providers in 2009? “I think you’re going to see providers financially struggle and some may fail, big and small,” predicts Chris Kane, COO of Pacific Pulmonary Services and spokesman for the Council for Quality Respiratory Care (CQRC). “I think you will see the impact of very sudden and very significant reimbursement changes hitting providers and patients in a delayed fashion, so that it will be several months before many providers realize they’re being paid much, much less. How they react to that and what they do will be very uncertain but is bound to create a lot of distress for the patient community. We expect for our business that 2009 will be the most challenging year we’ve ever had
- By Elisha Bury
- Nov 01, 2008
Funding Focus
With the recently published and long-awaited CPAP local coverage determinations (LCDs), the intake, billing and reimbursement departments will require some new checks and balances if providers have any expectation of payment. That’s because the LCDs, which apply to dates of service on or after Sept. 1*, include newly imposed hoops for the provider to jump through in order to file a clean claim. The following hoops, which will need to be cleared first by intake staff or customer service, include the collection of documents that must be in a provider’s files. These documents must reflect that the patient had a face-to-face evaluation prior to the sleep test.
- By Kelly Riley
- Sep 01, 2008
Funding Focus
Home sleep testing, also known as portable monitoring, has been around for years, yet the recent National Coverage Decision (NCD) memo issued by the Centers for Medicare & Medicaid Services (CMS) has many folks squirming. The NCD allows payment for CPAP devices based on unattended studies vs. traditional in-lab studies. Most HME providers want to be ready, but without a published Local Coverage Determination (LCD) from the Medicare Administrative Carriers (MAC) medical directors, they are hesitant to set company policy, communicate to referral sources or develop marketing plans.
- By Kelly Riley
- Jul 01, 2008
Funding Focus
A historical event in our industry is quickly approaching. Pending any new Congressional changes, effective January 2009, the payment ceiling will be reached for some of your existing oxygen patients, and your company will no longer receive monthly rental fees. January 2009 could be your worst single month in terms of revenue decreases, or it could be the same as any other month. The question is: Do you know?
- By Kelly Riley
- Jun 01, 2008
Legal Speak
As expected, on March 13, 2008, the Centers for Medicare & Medicaid Services (CMS) released a decision memo on a national coverage determination (NCD) for the use of home sleep tests to diagnose obstructive sleep apnea (OSA). CMS’ decision had been the subject of much speculation in the clinical and provider communities, and many expected CMS to approve home sleep studies for diagnosing OSA. In fact, CMS’ decision permits the use of home sleep tests, but CPAP is covered only for a trial period of up to 12 weeks regardless of the type of test performed, unless the beneficiary demonstrates that he is benefiting from therapy. The devices approved for home studies include Type II, III or IV with at least three channels.
- By Asela Cuervo
- May 01, 2008
Funding Focus
On March 14, the much-anticipated decision memo on a revised National Coverage Determination (NCD) for CPAP coverage for obstructive sleep apnea arrived from the Centers for Medicare & Medicaid Services (CMS). Unfortunately, with it came the same questions that have been posed by many in the industry for several months. These questions relate to a clear definition of beneficiary improvement; the role the HME can take in home sleep testing; how titration is to be accomplished; and reimbursement.
- By Kelly Riley
- May 01, 2008
Funding Focus
The phone is ringing, the trucks are traveling throughout your service area, and claims are flying through the electronic highways like never before! In addition, revenue is at an all-time high, and the new staff in your intake department really fits in well with the rest of the team. There is only one problem: Your receipts of cash are down. Without an influx of cash, everything else will eventually stop. But now, everyone is looking to the billing department to fix the problem.
- By Kelly Riley
- Apr 01, 2008
Funding Focus
- By Kelly Riley
- Mar 01, 2008
Funding Focus
Medicare has repeatedly changed the coverage guidelines for aerosolized medications, and did so again July 1, 2007.
- By Kelly Riley
- Jan 01, 2008
Respiratory Funding Update
For nebulizer medications, this year has been one of refinement. After many changes since the Medicare Modernization Act of 2003, reimbursement for nebulizer medications was further adjusted in the first half of the year.
- By Elisha Bury
- Sep 01, 2007
Legal Speak
Earlier this year, the Centers for Medicare & Medicaid Services (CMS) initiated a national coverage analysis (NCA) of the national coverage determination (NCD) for continuous positive airway pressure (CPAP) devices.
- By Asela Cuervo
- Sep 01, 2007
Funding Focus
The Centers for Medicare & Medicaid Services’ (CMS) final rule, mandating transfer of title of all oxygen equipment to the beneficiary at the end of 36 months (or possibly 13 months if Congress approves the president’s budget), should cause providers to pause and rethink their current process for collecting the patient financial portion. Comments in the final rule, in fact, state that patient costs contributed to the development of the equations used to calculate the formulas for payment methodology. CMS has clearly established that the provider has a reasonable expectation to be paid.
- By Kelly Riley
- Mar 01, 2007
Funding Focus
If you ask any person who has to collect accounts receivables whether they would rather collect from an insurance company versus a patient or family member, odds are they will choose the insurance company every time. Collecting for medical expenses is tough. Products and services provided by those in the HME industry are not something generally found on a Christmas or birthday wish list.
- By Kelly Riley
- Jan 01, 2007
Funding Focus
Sweeping changes: the one true constant those who work in the DME industry can count on. These changes have the potential to affect company owners, shareholders, employees and the patients they serve. The passing of the Deficit Reduction Act included a bill that limits rental payment to providers to 36 months for oxygen services. At the end of that period, ownership and responsibility for service and maintenance is transferred to the patient. Statistics show that for most companies, this transfer equates to a significant reduction in reimbursement for 35% of the oxygen patients they serve, as that is the number of patients that require long-term oxygen therapy (LTOT) beyond 36 months.
- By Kelly Riley
- Nov 01, 2006
Funding Focus
Where will oxygen providers be in 2007? 2008? Unfortunately, the answers are unclear. We have some guidelines from the Centers for Medicare and Medicaid Services (CMS); however, much of it is vague and some of it is simply inconceivable. Our fight has already started.
- By Claudia Amortegui
- Sep 01, 2006
Funding Focus
- By Claudia Amortegui
- Sep 01, 2006