Page 12 - HME Business, August 2017

News / Trends / Analysis
Many HME Categories Still See High Overturn Rates
Latest Audit Key survey shows continued appeal determinations in favor of providers on claims for several mainstay offerings.
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Appeal determinations
continue to favor providers in a variety of key HME categories, according to data collected during the Q1 2017 by the HME Audit Key program.
The latest data, available at bit.ly/2sWInEE, shows overturn rates of 68 percent for respira- tory products, 77 percent for ostomy, urological, wound care, and diabetic supplies, and 81 percent for NPWT devices and supplies.
Other highlights:
Beds and manual wheelchairs are a focus. Thirty- seven percent of hospital beds, support surfaces, and manual wheelchair new patients were subject to MAC prepayment audit, compared to 11 percent for respiratory products and single-digit rates for other major categories.
• 68 percent of MAC prepayment denials were appealed.
• 71 percent of completed MAC prepayment audits were paid upon review.
• 67 percent of completed appeal determina- tions nationwide were in favor of suppliers.
An American Association for Homecare project, The Audit Key program aims to help the industry better understand the impact of Medicare claims audits, and provide detailed information that helps make the industry’s legislative and regulatory case for reforming CMS’s audit program. So far it has
collected six quarters of data.
“While these results are bringing the burdensome
nature of the audit process into focus, we need more industry participation to be able to use this data to make our case to CMS and Capitol Hill,” a statement from the association read. “Please support this effort by participating in the next round.”
Providers Urged to Join Next Round
To that end, the next round of data submissions begins July 17. This will cover the time period through the 2nd Quarter of 2017. Providers that haven’t yet taken part, or that have skipped rounds can still submit data.
Registration and participation are free and open to all suppliers, not just AAHomecare members. To register and submit information, visit HMEAuditKey.org. Additional information is available at bit.ly/1k18xAv.
Also, submitting data continues to get easier. Providers using Brightree can print a report from their My Files folder to answer many of the opera- tional questions on the quarterly survey. Users can retrieve the report named AAH_Output.csv from the Inbox for the My Files page within Brightree, and then open the report in a spreadsheet program such as Microsoft Excel. Comprehensive guidance for using the Brightree report is available at bit.ly/2tgsdKF. n
Study: Most COPD Patients Not Receiving PAP Therapy
Despite Benefits
Modern PAP therapy has the potential to improve patient outcomes and reduce healthcare costs, yet most COPD patients go without.
A recent study of positive airway pressure (PAP) therapy rates for COPD patients found that more than 92 percent of patients are not receiving any form of PAP therapy, even though it can reduce rates of hospitalization.
“This study demonstrates the vast opportunity for the industry to further adopt recent innova- tions for COPD treatment,” said Eli Diacopoulos,
VP General Manager of Philips Respironics, in a prepared statement.
The study was funded by Royal Philips and led by Sairam Parthasarathy, professor of medi- cine and interim chief of Division of Pulmonary, Allergy, Critical Care and Sleep Medicine with University of Arizona College of Medicine. Parthasarathy analyzed data for more than 1.8 million COPD patients. He found that patients receiving Bi-level (BiPAP), continuous (CPAP) or noninvasive positive pressure ventilation (NIV) therapy had a lower risk of hospitalization than those not receiving PAP therapy. However, only 7.5 percent of COPD patients were receiving the therapy.
According to Parthasarathy, these findings have significant implications for patients and the health care system. “With improved awareness and implementation of PAP therapy as a treat- ment for COPD, we can lower the cost burden for health systems while allowing patients to recover in the comfort of their own homes,” he said in a prepared statement.
Diacopoulos said that many clinicians are
not informed about the latest COPD treatment methods, adding that “technologies, machines and even masks have advanced significantly since PAP therapy was first introduced.”
The study also found that patients with multiple chronic medical conditions, including sleep apnea, chronic respiratory failure and heart failure, combined with COPD, showed greater bene-
fits from PAP therapy. However, further study is needed to establish a causal connection between PAP therapy and reduced readmission rates for COPD patients. n
— Leila Meyer, leilameyer@gmail.com, or leilameyer.com.
UPCOMING COVERAGE
More industry intelligence is available at hme-business.com.
Developing Stories — Watch HME-Business and subscribe to e-Source during August to see continued coverage of the industry’s advocacy efforts to find more permanent relief for rural providers and their patients.
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