Georgia Association of Medical Equipment Suppliers
NEWS & NOTES


April 20 | 2017

In this issue:

  1. GAMES provides input.
  2. State Payors at GAMES Meeting
  3. Healthcare in the News
  4. Waiting on Gov. Deal
  5. Surprise fee changes to custom cushions & backs
  6. Augusta CMO Meet & Greet
  7. 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!


Platinum


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


Gold

BREAS New
Todd Tyson

Brightree
Melinda Mahoney

CAIRE

Lanier Hogan

Fisher & Paykel
Gregg Stahl

Cryogenic Inventory Solutions
Anne Holcombe
Travis Caulk

Mediware
Michelle Caldwell

ResMed
Jamie Griffis

The Compliance Team, Inc.
Jack Haire
Sandra Canally

The MED Group
Ted Metcalf

Silver

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

Medline

Brian Topchik

Medtronic
Chris Arapoff

Pharmacists Mutual Insurance
Hutton Madden


Bronze

Medtrade

Keving Gaffney

Pride Mobility Products
Steve Joyce

 GAMES Members Help Shape the Future of GAMMIS

On Thursday, April 20, 2017 GAMES members met with consultants for Georgia Medicaid to discuss next generation plans for the Georgia Medicaid Management Information System (GAMMIS), which involves transitioning to a service-centric modular framework.

Input was solicited in the areas of Claims Processing, Prior Authorization, Payment, Claim Edits/Audits, Customer Service, and Self-Service.

Some suggested improvements included access to same and similar billing information on the portal, full integration of managed care authorizations & billing, access to customer service online (can you say chat box?) to submit global edit issues, and more.

Thank you to everyone who submitted suggestions and especially thanks to Soft Touch Medical in Marietta for hosting this meeting!
 


State Payors at the GAMES 2017 Spring Meeting

Georgia Medicaid, DXC Technology, and the Medicaid CMO's will be in attendance at the GAMES Spring Meeting!

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!

Healthcare in the News

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

Secret Date On Hospital Inspections May Soon Become Public
The public could soon get a look at confidential reports about errors, mishaps and mix-ups in the nation's hospitals that put patients' health and safety at risk, under a groundbreaking proposal from federal health officials.

Personal care home owners or employees rarely face criminal charges
Many of the most vulnerable Georgians live in hundreds of personal care homes in Georgia, but no state law specifically provides them protection.

Georgia Supreme Court hears arguments in Northside records case
Is the nonprofit Northside Hospital Inc. subject to the state's open records law?

Georgia hospitals worth $47.8 billion to state economy
Georgia's hospitals are vital to the health of the state's economy as well as its residents.


So What is Going On with DME Licensure?

Two important pieces of legislation of interest to GAMES members, SB41, a bill to provide for licensure of Durable Medical Equipment Suppliers and HB206, the Pharmacy Audit Bill of Rights were both passed on the last day of the 2017 legislative session. These are not law however until signed by Governor Nathan Deal. He has 40 days (until May 10) to either sign these into law, or to use his red pen... GAMES will keep members posted as soon as we know anything!
Medicare Establishes Set Fees for Custom Cushions and Backs

From VGM’s Reimbursement team, Ronda Buhrmester and Dan Fedor


This is a heads up to those who provide custom cushions (E2609) and backs (E2617) to Medicare beneficiaries!

The Jurisdiction B and C DME MAC has decided to develop set fees for these custom items and did this internally without notice to the provider community. As of today (April 18), the Jurisdiction A and D DME MAC has NOT implemented this change.

This action by the Jurisdiction B and C DME MAC came to light when providers noticed the allowed amounts for these items dropped by approximately 70% overnight, and they brought this to our attention.

Because these are custom items (miscellaneous), they were individually priced prior to this blind change and were averaging approximately 70% of MSRP/supplier price. The allowed amount varied significantly because they are custom fabricated and not prefabricated.

Please be aware that as of today, the set allowable for these codes are approximately $450 for E2609 and $550 for E2617, regardless of MSRP/supplier price or your cost of the item. We are hearing that the new established allowables will not even cover acquisition cost for any of the products that are coded as custom fabricated.
There are many issues that are unsettling with how this came about and all are being addressed with CMS and the DME MACs as you read this article. All industry advocates are aware of these issues and are reaching out to get answers and request that this change be rescinded so as not to impact access to these custom, medically necessary products.

The take away for now is knowing that the allowed amount as of today is approximately $450 for E2609 and $550 for E2617. We want providers to have this information to be able to make an informed decision before providing these items.

More information will be forthcoming as there are council meetings on April 19 for DME MAC C and April 20 for DME MAC B, where we hope to obtain more information on how this was determined and why the provider community was not given advance notice of this change.

CMO Meet and Greet Tomorrow in Augusta!

Friday, April 21, 2017
DOCTORS HOSPITAL OF AUGUSTA
3651 Wheeler Rd., Augusta, GA 30929
8:00am – 2:30pm

CLICK HERE for details!

Save These Dates!
April 26-27, 2017
Arlington, VA

Georgia Medicaid Fair

Tuesday, May 2
Cobb Energy Centre

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

GAMES 2017 Annual Meeting
August 27 - 29, 2017
Jekyll

 

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