Georgia Association of Medical Equipment Suppliers

May 4 | 2017

In this issue:

  1. Audit Bill of Rights Now Law!
  2. VGM Call to Action
  3. Please Explain...
  4. Jurisdiction C Update
  5. Healthcare in the News
  6. Save these dates!

GAMES Platinum Members!

GAMES Associate Members
Support the associate members who support GAMES. If your vendors aren't on the list, ask them why!


Airgas Puritan Medical !
Christa Forrester
Mark Bradshaw

Drive DeVilbiss Healthcare
Joe Gessner
Steve Wakser

Philips Respironics
Susan Yenney
Kimberly Williamson

VGM Group
Gil McCall
Pat Aydelott


Todd Tyson

Melinda Mahoney


Lanier Hogan

Fisher & Paykel
Gregg Stahl

Cryogenic Inventory Solutions
Anne Holcombe
Travis Caulk

Michelle Caldwell

Jamie Griffis

The Compliance Team, Inc.
Jack Haire
Sandra Canally

The MED Group
Ted Metcalf


Allegiance Group
Bruce Gehring

Barbara's Billing & Consulting
Barbara Penzien

Compass Health
Joe Toth

Linde Healthcare
Clay Stalnaker

McKesson Medical Surgical
Chip Wooten

Medical Specialties Distributors
Pat Burke


Brian Topchik

Chris Arapoff

Pharmacists Mutual Insurance
Hutton Madden



Keving Gaffney

Pride Mobility Products
Steve Joyce

Audit Bill of Rights Signed Into Law by Governor Deal! 

In big news for Medicaid providers, Georgia Governor Nathan Deal signed HB 206 into law this week. HB 206 updates the Pharmacy Audit Bill of Rights by extending due process rights to all Medicaid providers who are subject to recoupment of paid claims.

Unlike in the past, providers now will have the right to file additional paperwork or request a hearing before a recoupment of funds can occur. Clerical or other errors can no longer constitute a basis to recoup payments!

This bill passed the legislature as HB 916 but was vetoed last year due to overly broad language as to how the statute would have applied. The current version, HB 206, took Governor Deal’s concerns into account. Still, it took a great deal of work and collaboration between GAMES, the Georgia Pharmacy Association, and Service Providers for Adults with Developmental Disabilities (SPADD) and the leadership of the Department of Community Health (DCH) to get the bill passed at literally one minute past midnight on the final day of the 2017 General Assembly session.

GAMES wishes to thank Representative Trey Kelley and Senator Renee Unterman for their tireless work in making sure this bill moved through the process and that it passed in a form that Governor Deal could ultimately sign. We also wish to thank Governor Deal for his consideration for Medicaid providers in signing this important bill.

CLICK HERE to read the bill.

Call to Action: Continuing the Fight for Sustainable Rates

From VGM

With this week's release of the updated fee schedules for the July 2016 adjustment for rural and non-bid areas, previous estimates have been confirmed that providers were hoodwinked by CMS.

As expected, CMS adjusted the new rates by including prices from the most recent round of competitive bidding. Including the additional round of competitive bidding has reduced the reimbursement that is owed to providers by an additional 6-11 percent, depending on the location and product.

"CMS incorporating July 1 competitive bidding rates into the retroactive payment that providers are owed goes directly against the intent of Congress to provide relief to rural providers who are struggling,” said John Gallagher, VP of VGM Government Relations.

To give providers an idea of what these cuts look like, we have compiled a chart to illustrate the differences in reimbursement and where they are now. Below are the average rates of most commonly used codes in the contiguous United States:

CLICK HERE for the comparison chart and to read the rest of the VGM blog.

CLICK HERE for the announcement from CMS.

GAMES President, Tyler Riddle of MRS Homecare, responds to CMS Announcement!

"CMS’ decision to alter these rates without explanation not only is a slap in the face to the DME providers left servicing customers, but is an affront to the intent of the Congress that passed the CURES Act."

CLICK HERE to read Tyler's letter to HHS Sec. Price. (He sent similar letters to his US Representative and both Senators.)

New Speaker added!
GAMES 2017 Spring Meeting

In addition to Georgia Medicaid, DXC Technology, and the Medicaid CMO's, AAHomecare's Director of Government Relations, Jay Witter will be at the GAMES meeting next week in Atlanta.

In order to fulfill the requirements of the 21st Century Cures Act, this week CMS released the retroactive reimbursement rates for certain DME items as mandated by this law. These rates do not reflect the fee schedule as of January 1, 2016 as expected by the industry. CMS appears to have used some sort of funny math as a way to reduce these rates by 6 -11 %!

Jay Witter, senior director of government affairs at AAHomecare will offer insight from DC into this situation.

Jay brings sixteen years of legislative, political, and management experience to AAHomecare, which serves him well in advancing our legislative initiatives on Capitol Hill, as well as coordinating our political activities. His years working on Capitol Hill for several members of the House of Representatives provide valuable knowledge in the legislative and political processes, as well as helping cultivate invaluable relationships on The Hill that assist his lobbying for homecare issues on a daily basis.

On Thursday, May 11, 2017, HME owners, operators, managers, as well as compliance officers and senior-level billing & reimbursement personnel are all invited to Atlanta for a
fast-paced, action-packed, information-filled day!

Soup To Nuts: Building Your Compliance Program so you can still eat your soup and not go nuts! CLICK HERE for agenda and registration information.

Your hosts for the day:

Laura Williard is the senior director of payer relations for the American Association for Homecare. She has served in the HME community for more than 24 years, in regulatory affairs, reimbursement, compliance, and contracting.

Wayne H. van Halem, AHFI, CFE is the founder and President of The van
Halem Group. A former auditor and national appeals director with Medicare, van Halem leads his team as they assist providers in navigating the complex issues related to audits, appeals, enrollment, and compliance.

CLICK HERE to learn more!

Update from the Jurisdiction C Council
Jurisdiction C Council

GAMES is a member of the Jurisdiction C Council, a coalition of suppliers for all states handled by CGS. Its purpose is to meet quarterly with CGS, the Jurisdiction C DME MAC, to suggest, review and resolve problems in operations.

GAMES is represented on the Council by Trish Clayton of Barnes Healthcare Services. Following are Trish's notes from the recent meeting. (Please note these are not the official meeting minutes, but that Trish is sharing her personal notes with GAMES members.)

News from the Jurisdiction C Council meeting April 18thand 19th.

CGS is discussing with CMS the details for reprocessingthe Cures Act Relief claims affected for dates of service July 1, 2016 - December 31, 2016. They are still not sure when the fee schedule will be available. There are over 4 million claims that have to be reprocessed. As of now they do not have a plan touse any type of identification on these adjusted claims so that providers will be able to easily identifythe Cures Actadjusted claims on the remits. The council has asked for the consideration of using a remark code or some type of identifier for these claims. We explained that providers needed to be able to distinguish between the regular adjusted claims from the Cures Act adjusted claims so that their cash posting departments are able to make the appropriate adjustments. CGS had agreed to take this into consideration.

HCPCS codes E2609 and E2617 are being analyzedto make sure the fees were developed correctly. They have suspended payment on new claims until this analysis is complete. The suspension was effective April 17th and should take 2 weeks to complete for both codes. 

CGS is still encouraging providers to go on line and take the surveys. All of the surveys are reviewed and improvements are made based on these comments.

Facebook is a great place to receive instant information and updates.

Mr. Wizard has been expanded its researchto provide more details on why a claim was denied rather than just what on the remits. As of the meeting on April 19th the April data was not available yet.

AESOP program for provider exemptions for low error rates is working well and they are happy with the resultsthus far. There were 8 new providers exclude last quarter.

CGS does a monthly review the ADR letterswith no responses and they will be contacting these providers. These letters are sent to the "Pay to Address” listed on your 855S form.

Local Coverage Determinations (LCD’s) not have 3 parts to them. 1. Coverage/ Policy information 2. Related Policy Article 3. Standard Documentation Requirements

CLICK HEREto contact GAMES’ representatives to the Jurisdiction C Council or to submit questions. The compiled questions will then be submitted to CGS.

Healthcare in the News

These news clips were shared with GAMES by our state lobbyists, Southern Strategy Group:

Gov. Deal To Sign Bill, Set Limits On Ga. Drug Treatment Centers
Addiction treatment centers in Georgia will be more strictly regulated under legislation the state's governor plans to sign.

Georgia losing patience with drug-treatment tourists
In the northwest corner of Georgia, where cows and crops vastly outnumber people, a small cluster of privately owned treatment centers has sprung up in recent years for heroin and prescription painkiller addicts.

Memorial buyer HCA purchases Waycross hospital

On Monday, Satilla Regional Medical Center in Waycross became the latest hospital to join for-profit healthcare giant Hospital Corporation of America, integrating into the company's South Atlantic Division and adopting a new name - Memorial Satilla Health.

Governor signs bill designating hospitals by level of cardiac care
Gov. Nathan Deal traveled to Gainesville Tuesday to sign a bill designating three levels of cardiac care, which officials said will help patients and emergency responders better understand where to transport those who have had a heart attack. 

Georgians with disabilities don't get required help to renew benefits, suit says
Three Georgians with disabilities have filed a lawsuit alleging that state agencies have failed to provide accommodations to help them maintain their eligibility for food stamps and Medicaid.

Doctors, Hospitals Say Latest Trumpcare Version A Bigger Disaster
The latest version of the American Health Care Act, also known as Trumpcare, has providers of medical care mobilizing once again to derail what they say is an even worse version than what U.S. House Speaker Paul Ryan wouldn't bring to a vote last month. 

Save These Dates!

GAMES Spring Meeting
"Soup To Nuts: Building Your Compliance Program so you can still eat your soup and not go nuts!"
Thursday, May 11, 2017
Atlanta, GA

AAHomecare Washington Legislative Conference
May 24 - 25, 2017
Washington, DC

VGM Heartland Conference 2017
June 12-15, 2017
Waterloo, IA

GAMES 2017 Annual Meeting
August 27 - 29, 2017
Jekyll Island, GA