CMS Announces 2005 Oxygen Fee Schedule
As required by section 302(c) of the Medicare Modernization Act, CMS recently announced reductions in monthly payment amounts for oxygen and oxygen equipment, with oxygen rates ranging from $194.48 to $200.41 for stationary oxygen and from $30.57 to $32.08 for portable equipment. The reductions were made based on the percentage difference between Medicare’s 2002 monthly payment amounts for each state and the median 2002 Federal Employees Health Benefits Program (FEHBP) price reported on March 30, 2005, by the Office of Inspector General (OIG), Department of Health and Human Services. Had the reimbursement reductions associated with the new fee schedule been in effect for the same time period in 2004 as they will be for 2005, American HomePatient Inc, Brentwood, Tenn, one of the nation’s largest home health care providers with 276 centers in 35 states, estimates that revenue for 2004 would have been reduced by approximately $6.2 million.

Kay Cox

Last year, AAHomecare collected data about the costs of providing home oxygen to Medicare beneficiaries and shared with CMS and OIG this home oxygen information and concern about statistical issues in calculations made by OIG. In December, CMS announced that OIG needed to collect additional data before the FEHBP medians for oxygen and oxygen equipment could be finalized. For the March 30 report, the OIG gathered additional data regarding the pricing of oxygen contents for the figures used to compute the median FEHBP price. “These reimbursement cuts for oxygen are several percent-age points lower than they would have been if AAHomecare had not pressed OIG and CMS on this issue,” says Kay Cox, president and CEO of AAHomecare. “AAHomecare made a successful case for CMS to ask OIG to take the unusual step of re-examining the data in the initial OIG report on home oxygen. We still have questions about some of the methodology used by OIG, but we are very grateful for the level of openness and cooperation at the OIG and CMS. AAHomecare and its members will continue a dialogue with CMS and OIG to protect the oxygen benefit in Medicare.”

MAMES Provider of the Year
Phoenix Medical Services Inc, Roseville, MN, received the Fifth Annual MAMES Provider of the Year award at the Midwest Association for Medical Equipment Services (MAMES) 2005 Spring Convention and Exhibition. The award is given to a member company or individual chosen by MAMES membership committee who demonstrates a high commitment to professionalism, participation with MAMES, and positive change in the industry. Joan Nerz, owner, Phoenix Medical Services Inc, accepted the award on behalf of her company. MAMES is an organization comprised of companies that provide HME, supplies and services, home care services, and the distribution and manufacture of related products located in Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota.

Gearing Up for DC
Home care providers from across the United States will gather in Washington, DC, on June 7 to 10 to deliver the message that home care is one of the key answers to the nation’s health care crisis in Medicare and Medicaid. “We will bring a number of specific policy concerns to Congress as well as the larger message that home care is patient-preferred, clinically proven, and cost-effective,” says Kay Cox, president and CEO of AAHomecare. The conference also serves as AAHomecare’s annual business meeting and will feature speakers including Rep Mike Ross (D-Ark), the only home care business owner in Congress; Thomas Scully, senior counsel at Alston & Bird and former Administrator of CMS; and Bonnie St John, paralympian, author, Rhodes scholar, and motivational speaker.

From left: Melissa Milinovich (Ms Wheel-chair Ohio), Shanda Grubb (1st runner up), and Crisi Warner (2nd runner-up).

Ms Wheelchair Ohio Crowned
Despite local blizzard weather conditions at the Ms Wheelchair Pageant, eight women recently vied for the title of Ms Wheelchair Ohio. Each of the participants shared remarkable stories and accomplishments, but ultimately, it was Melissa Milinovich of Cincinnati who was selected winner of the 2005 Ms Wheelchair Ohio Pageant. Shanda Grubb finished as first runner up, and Crisi Warner was second runner up.

Providers Urged to Support Medicaid
Members of AAHomecare were urged to express support for HR 985 and S 338, bills to establish a bipartisan commission on Medicaid. Both bills have broad, bipartisan support in Congress. The commission would review and make recommendations with respect to Medicaid’s major functions, delineation of federal and state roles, the long-term financial condition of Medicaid, matching payments, dual eligibility, and health care disparities.

State Senator Phil Erdman

Many states continue to examine the Medicaid issue. Nebraska State Sen Phil Erdman (R-Bayard) has introduced a bill (LB 709) calling for a study. Medicaid is the second-largest and fastest-growing slice of the budget pie in Nebraska, rising an average of 11% annually over the past two decades, according to the Associated Press. At both federal and state levels, calls for spending cuts have been met with concern about preserving access to care provided by Medicaid.

Assuring Accurate Medicare Payments
CMS announced a new demonstration project using recovery audit contractors (RACs) as part of CMS’ efforts to assure accurate Medicare payments. The demonstration will use the RACs to search for improper Medicare payments that may have been made to health care providers and that were not detected through existing program integrity efforts. The present recovery audit contracts focus on Part A Medicare claims and exclude evaluation and management services. Currently, the Medicare contractors, which include carriers, fiscal intermediaries, and DMERCs, examine a defined percentage of claims during their medical review. “There are two parts to making certain that Medicare dollars go to their intended purposes,” says CMS Administrator Mark McClellan, MD, PhD. “First, we need clear and straightforward rules to assure that fair payments are made for services to Medicare beneficiaries, and second we need effective mechanisms in place to detect and respond to inappropriate billing. In conjunction with new steps to ensure Medicare’s billing rules are clear, this demonstration will let us test a new approach to ensure that payments made to providers are accurate.”