Breaking News: CMS Temporarily Halts RAC Audits to Transition Contracts

After receiving pressure from more than 111 individual members of congress about the overaggressive nature of CMS’ RAC audit program, CMS announced earlier this week that they will temporarily halt new RAC audit requests to allow existing contracts with audit contractors to expire.  

This announcement is in stark contrast to previous guidance from CMS, in which CMS announced they planned to extend the current contracts through the implementation of the new contracts. So, this is quite a policy change in just a few months as pressure has been ratcheted up on CMS from congress.

CMS anticipates new contracts with RAC’s to be completed in the next few months. However, February 27, 2014 will be the final day current RAC’s can send an Additional Document Request (ADR) request to a provider. Unfortunately, once the new RAC contracts are signed, the new audit contractors will have the ability to go back and review claims submitted throughout the hiatus time period. Current RACs will be allowed to finish work on existing audits that have already been initiated.

In their release, CMS announced that they are reviewing Additional Document Request (ADR) timeframes for review, a potential limit on ADR requests and facilitating better communications between the RACs, MACs and providers.  CMS has also agreed with an OIG recommendation that RACs performance evaluation must include the amount of claims that are identified and eventually overturned at a higher level of appeal.

There are additional changes that CMS is reportedly making to the new contracts for auditors, including:

  1. RAC’s will have to wait 30 days to allow for a discussion before sending the claim to the MAC for adjustment. Meaning that providers will not have to choose between initiating a discussion and an appeal.
  2. RAC’s will be required to confirm with the provider receipt of a discussion request within three days.
  3. RAC’s will wait until the second level of appeal is fully exhausted before they receive their contingency fee.
  4. CMS will establish new and revised ADR limits that will be diversified across different claim types (e.g., inpatient, outpatient).
  5. CMS will require RAC’s to adjust the ADR limits in accordance with a provider’s denial rate. Providers with low denial rates will have lower ADR limits while providers with high denial rates will have higher ADR limits.
Now is the time to keep the pressure on CMS and your member of congress to ensure our voice is heard loud and clear throughout the time CMS is awarding the new RAC contracts. Accountability and transparency are badly needed in the RAC program and we must continue to voice our frustrations to ensure we are represented
in any changes that are made.                                                       Information source: VGM

 

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Colonial Medical Supplies partners with Airlife Medical

Colonial Medical Supplies partners with Airlife Medical

 ORLANDO, FLA. – November 30th 2013, Colonial Medical Supplies has become a minority shareholder of Airlife Medical in Auburndale Florida.  The partnership will allow Airlife to service Medicare Competitive bid patients in Florida as well as other private insurance contracts held by Colonial Medical Supplies.

About Colonial Medical Supplies:

Since 1957, Colonial Medical Supplies has been a family owned, family operated business with 3 locations in Fl.  The corporate office is located in Altamonte Springs, and is the site for one of the largest retail DME companies in the country, with over 12,000 square feet dedicated to retail DME products.  Colonial Medical Supplies was awarded over 600 competitive bid contracts in nearly every CBA, for the following product categories:

  •       Walkers
  •       Oxygen
  •       CPAP
  •       Manual Wheelchairs
  •       Power Wheelchairs
  •       Hospital Beds
  •       Support Surfaces

Colonial has been serving patients in CBA’s through subcontracting agreements with DME companies in CB area, however late in 2013 Colonial began seeking strategic partners who can serve patients directly.   Airlife Medical is Colonial’s third acquisition this year, and the company continues to seek additional partners in other CBA’s.

Quote from David Bruinsma, CEO Colonial Medical Supplies:

We are thrilled to be working with Airlife Medical and Rick Brauckmuller.   Rick has built an amazingly efficient well-run company from the ground up, and is exactly the type of partner we are looking for.   Due to the common ownership, Airlife has been added to the Medicare Provider Directory as a competitive bid winner under the Colonial contract, as well as other private insurance contracts which Colonial is contracted.  We built a custom platform to work with subcontractors that automates many of the intake processes.  The system has served us well, and we continue to process thousands of orders each month through our subcontractor network, but we realize subcontracting is not always the most efficient method to provide Medicare beneficiaries DME in competitive bid markets.   

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Colonial Medical Supplies to Accept Blue Cross Blue Shield

 

 

FOR IMMEDIATE RELEASE:

Colonial Medical Supplies to Accept Blue Cross Blue Shield

Largest Medical Equipment Supplier in Central Florida to Become In-Network Provider for BCBS

Altamonte Springs, FL, May 14, 2012—Colonial Medical Supplies announced today that the company will become an in-network provider for Blue Cross Blue Shield beginning immediately. The new contract will allow Colonial Medical Supplies to bill BCBS for equipment purchases by patients with BCBS health insurance as in-network purchases.

 “It has been difficult for BCBS patients to find a qualified in-network provider,” said David Bruinsma, CEO of Colonial Medical Supplies. “While many insurance companies are taking steps to limit their expenses by reducing access, BCBS through its partnership with CareCentrix has gone the opposite direction and has increased its network of providers to give its members more choices. I think this demonstrates the insurance company’s commitment to not conforming to substandard industry practices.”

 Colonial Medical Supplies provides the largest selection of medical equipment in Central Florida. It is also a certified custom wheelchair provider and has a respiratory therapist on staff to help customers. The new contract will allow BCBS patients to purchase equipment such as scooters, orthotics, and CPAP supplies more easily and have the billing sent to the insurance company at no charge. Open six days a week, Colonial Medical Supplies offers three convenient locations in Central Florida and provides same-day service to many of its customers. Along with free shipping and free home delivery, the company offers same-day pickup at any of its three locations.

About Colonial Medical Supplies

Colonial Medical Supplies is the largest medical equipment supplier in Central Florida, with locations in Kissimmee, Orlando, and Altamonte Springs. The company has been providing quality medical products and services since 1957, and is currently managed by the second generation of the Bruinsma family, who took over after Betty and Frank Bruinsma started the company. Visit: http://www.colonialmed.com.

Media Contact:
David Bruinsma
CEO
Colonial Medical Supplies
614 E Altamonte Dr.
Altamonte Springs, FL 32701
407-849-6455
david@colonialmed.com

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Bathroom Struggles

Having difficulties getting up from your low toilet seat or need something to grip onto to support you as you get on or off of your toilet seat? A 3-in-1 commode could be the answer to your problems. The standard 3-in-1 commode is height adjustable so you can raise it above your toilet seat making it easier to get off of. Also with the commodes’ raised arms, you can give yourself some extra leverage getting up from the commode, or you can use the arms to steady yourself as you prepare to be seated on the commode. So there are two uses of the commode: a raised toilet seat, and with the raised arms you get a very secure toilet safety frame. The third use of the standard 3-in-1 commode is that you can use it for bedside use. This means that if you are unable to walk the distance to the toilet, which is very common after a hip or knee surgery, you can have the commode right next to your bed.

Specialty commodes are less common and most are unaware that there are other options for commodes to fit different needs. The standard commode is usually made of steel, however, there is an aluminum commode. The aluminum commode has all the same features as the standard but is aluminum instead of steel, this is particularly important, with the aluminum the commode will not rust when it gets wet meaning it can be used as a shower chair as well as the three other uses of a standard 3-in-1 commode. Another less known commode type is the drop-arm commode. For someone transferring from another type of seated mobility product such as a scooter, wheelchair, or powerchair transferring can be difficult as it is but with the drop-arm it literally means that by pushing a tab the arm will drop to the side so it is out of the way making the transfer process smoother and easier. There are also drop-arm commodes with padding on the seat and arms for additional comfort. Bariatric commodes are available as well, as long as the user is over 350lbs. It is a reinforced steel framed commode with a starting weight capacity of about 550lbs, some can hold up to 1000lbs so they make a very strong and sturdy bariatric commode. Next time you or someone you know is having any bathroom struggles and a commode may be answer we can help get the one that would best suit you.

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Philip Respironics’ New Portable Oxygen Concentrator dubbed SimplyGo

Murrysville, Pa., USA, February 21, 2012 /PRNewswire/ — Philips Respironics, a unit of Royal Philips Electronics (NYSE: PHG, AEX: PHI), is introducing its latest advancement in oxygen therapy. SimplyGo is the only portable oxygen concentrator (POC) to offer continuous flow (up to 2 liters per minute) and pulse-dose delivery in a single device weighing 10 pounds or less. With this combination of capabilities, the SimplyGo POC helps homecare providers manage the therapy and lifestyle needs of nearly all oxygen users.

“Philips Respironics is dedicated to offering homecare providers a variety of innovative products that improve treatment and increase mobility for oxygen users, streamline business operations, and simplify therapy,” said Eli Diacopoulos, Senior Director, General Manager, Home Respiratory, Philips Home Healthcare Solutions. “SimplyGo is an essential addition to Philips’ extensive line of home oxygen products. It’s a new breed of portable concentrator that simplifies the care and management of nearly all oxygen users.”

Like all POCs, SimplyGo delivers pulse dose oxygen—a burst of oxygen triggered when the user starts to take a breath. But SimplyGo is different from smaller devices because it is also capable of delivering oxygen continuously, similar to stationary concentrators used at home. With oxygen output of up to four times that of some lightweight POCs, SimplyGo can meet the portable needs of nearly all oxygen users including those who are highly active or require continuous flow.

Philips designed its latest portable oxygen concentrator with a long-life compressor, high-impact resistant design and oversized cart wheels in order to be rugged and easy-to-use. SimplyGo was tested and subjected to extreme conditions, including impacts, vibrations and temperatures, to deliver reliable performance day in and day out in real-life conditions experienced by oxygen users.

SimplyGo comes with an attractive, functional carrying case; fold-up mobile cart; intuitive, easy-to-read screen; and detachable accessory bag. A lightweight and compact battery adds to its portability. Extra batteries are available and can fit easily into the zippered pouch on the carrying case or accessories bag for extended use.

Additionally, two-, three-, or five-year warranties and flexible service programs are offered with SimplyGo to give homecare providers a variety of options to meet their individual business needs. SimplyGo’s design and comprehensive service tools also allow technicians to perform work right on site, if they choose.

This newest innovation from Philips Respironics provides oxygen patients with greater mobility and simplicity to help improve their lives. It is being launched in North America and will soon be followed with international availability.

For more information, visit:
www.philips.com/simplygo

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iHealth takes smartphones to the next level.

Smartphones have become a huge asset to the lives of many.  From such a small device, you are able to accomplish phone calls, reading/responding to emails, entertainment in the form of games and movies, photography, blogging, a variety documentation programs, and it doesn’t stop there.  A quirky response to someone saying “I wish there was a program that could do …”  or “If only my phone could do….” would be simply put “There’s an app for that.”   They have apps for anything now-a-days and only the surface of the medical industry has been touched.  Luckily, iHealth has announced at CES 2012 they will be coming out with 3 new devices this year to help out patients organize and simplify their devices for their medical needs.

First up, iHealth’s Blood Pressure monitor will be getting a complete upgrade to become wireless.  It will send your vitals over Bluetooth to an app on your iPhone.  No longer do you need a cumbersome BP monitor with a wire/tubing that could get in the way.  Second in the line up is iHealth’s Smart Glucometer.   Diabetes is becoming more common in today’s society.  Anyone who is a diabetic knows that their vitals  must be constantly monitored and logged.  What better way than with a simple attachment for your phone rather than a completely seperate glucometer.  The final device iHealth has in store is a Wireless Body Fat Scale that has upgraded their Digital Scale and allowed it to measure your body fat and send the information to your device.

The best part of all this is that all of your vitals and information is automatically send to and stored on your idevice (whether it be iPod touch, iPhone, or iPad) which will have it put on the cloud in one nice, neat spreadsheet.  No more having to write your information in a journal.

Great!  Now, you may be thinking, how can I get this paid for by my insurance.  Blood pressure monitors (also known as sphygmomanometers) are covered under private insurances as in United Healthcare, Aetna, and others .  Insurances usually pay for the least costly alternatives so there may be a small upgrade fee to allow you to get the latest technology out.  Glucometers can be covered by more than just private insurance but also Medicare.  Again, there may be a small upgrade fee to get iHealth’s Smart Glucometer, but a portion can be paid by your insurance.  If these devices can be approved, worker’s compensation can cover them completely.  As soon as these devices are out to the public, why not let one of our Customer Service Representatives at Colonial Medical Supplies try to get your device approved through your insurance.  To start, all you will need is a prescription stating  the device you are looking to get.  If you have any other questions, please don’t hesitate to contact us at csr@colonialmed.com.

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Alternative Funding Sources

Here at Colonial Medical Supplies we realize an individual’s needs for equipment may not always be covered by their insurance company. Here are few programs to help with those needs for individuals that can’t afford the cost of expensive equipment that is not regularly covered.

Vocational Rehabilitation is a state run program to help the disabled find work or be able to keep their job by providing equipment that may not always be covered by insurance. This is perfect for an individual that is willing and able to work but may need something such as a scooter or handicap accessible van to make the job work. There are many other items they can help with such as standers, car lifts, and even shower chairs if the patient qualifies. The Brain and Spinal Cord Injury program is also a state run program but is more directly established for patients that have a brain or spinal cord injury. They can help with many items needed for new patients’ after a severe injury. Items commonly covered by this program are ramps, home modifications, shower wheelchairs, and standers.

There are also many programs established for specific diseases. These include, but are not limited to, the Muscular Dystrophies Association, National Multiple Sclerosis Society, ALS foundation, and 4MYCHILD. These are all examples of other programs out there to help those in need. While some will offer help with funding, others may help with support and trying to find whatever that individual’s needs are. Colonial Medical Supplies strives to participate with as many programs as possible making it
easier for the patient to seek the help they need. Please contact our staff anytime for contact information for these programs.

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OH NO!!! WHAT ARE THESE SPIDERS?

Over 50 million Americans have jobs where they have a required time in a standing position. There are also those, who spend most of their time at work in a sitting position. Due to these jobs and its vigorous tasks, numbers of people develop various health conditions. Some of them include: poor circulation, swelling in the feet and legs, foot problems, joint damage, heart and circulatory problems, possible pregnancy difficulties, and of course varicose veins (aka. spider veins). Although you may find yourself saying the same thing over and over again, “well I do not have a choice, but to work” there are definitely preventative things you can do to remedy your situation.

Here, at Colonial Medical Supplies, we have a variety of medical equipment that has helped our customers achieve a satisfactory level of comfort during their work day. There is a large selection of foot products: metatarsal cushions, toe protectors, arch bands and much more. We also have a brilliant product called compression stockings. Being around for decades, compression stockings are known by many different names. They are called support hose, anti- embolism socks, diabetic socks, but the majority of the time they all point to the same thing, which is compression. Compression stockings are specialized hosiery items designed to increase and promote blood circulation. Their main therapeutic purpose is to provide graduated pressure on the lower leg and foot and in some cases, the thigh, to alleviate circulatory problems. These stockings use stronger elastics to create a significant pressure on the legs, ankles and feet. They are the tightest at the ankles, and gradually become less constrictive towards the knees and thighs. By compressing the surface veins, arteries and muscles, the circulating blood is forced through narrower circulatory channels. As a result, the pressure in the arteries is increased which causes more blood flow to return to the heart and less blood to pool in the feet.

There are two types of compression stockings in the market right now. Anti-embolism stockings are known as T.E.D. and are worn when non-ambulatory or post-surgical scenarios are present. They help prevent pooling of blood in the legs that could lead to a venous thrombosis. The word T.E.D is often confused with compression, because of what customers experience when they have either been released from the hospital or after surgery treatments. The most important thing to understand is that if you are ambulatory, in other words can walk, this stocking is not for you. Another type is gradient compression stockings, which are worn by those, who are ambulatory. In most cases they assist the calf muscles to perform their pumping action more efficiently to return blood to the heart.

Bottom lines is, if you find yourself looking in the mirror and start noticing those frightening looking spiders crawling up your calves and thighs, please take a minute to think that Colonial Medical Supplies will have the solution to your problem.

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The Three Types of Rolling Walkers Colonial Medical Supplies Offers Through Medicare

Walkers are needed for all types of situations; sometimes customers are just not sure what type of walker is best for their situation. What type of walker you choose should be based on personal preference and your ability and balance. You can discuss with your doctor which walker he thinks is best for you depending on your physical requirements if you are unsure what walker to choose. There are three types of rolling walkers.

The first of the three being a four wheeled Rollator walker with seat. The Rollator walker is very easy to. This type of walker has four wheels, seat, basket and push down brakes that lock. The push down brakes offered by this walker ensures safety when standing up or sitting on the seat. The large padded seat makes it easy for you to rest during long trips, or even just a walk in the grocery store. The Rollator is easy to fold up and put into the trunk of your car. The Rollator is covered eighty percent by Medicare with a valid prescription that must state four wheeled walker with seat and brakes. These walkers come in many different colors. Rollators are not made as sturdy as a wheelchair, and cannot be a used as a substitute.

The second type of rolling walker is the two wheeled rolling walker. The two wheeled walker has two wheels in the front and two legs in the back with rubber tips to offer better stability. This type of walker is aluminum very simple to just fold up each side and store away. This walker is also covered by Medicare at eighty percent with a valid prescription that states rolling walker.

The third type of rolling walker is the three wheeled walker. This type of walker has three wheels, two in the back and one in the front, and also includes a pocket to put your personal belongings. These walkers are not covered by Medicare, but are very easy to maneuver through small spaces such as a doctor office. These walkers come in a wide variety of colors and patterns.

Medicare will cover a new walker every five years, and replacement wheels can be purchased through Medicare with in these five years. Walkers can be very useful and can come in all colors and brands. The most important part about choosing a walker is choosing one that’s right for you and that fits your needs.

Aetna, United healthcare and many other private insurances follow the same guidelines as Medicare.

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Medicare Cushion Requirements

Here at Colonial Medical Supplies we are dedicated to providing the correct cushion for each patient according to their individual needs. Medicare may sometimes help with the expense of a cushion if the patient qualifies. This is very helpful given that most cushion cost range from $50.00 to $500.00.

Here is a quick summary of what Medicare requires to be covered for a cushion. First the patient must have a wheelchair. If the patient is not in a wheelchair they do not qualify. A transport/companion chair does not qualify for any cushion. The patient will automatically qualify for a basic cushion on a standard wheelchair. If the patient is in a power wheelchair, the power wheelchair must have a solid or sling seat. A captain seat will not qualify for any type of additional cushion.

If the patient needs a higher end cushion due to positioning or pressure relieving needs, the diagnosis will determine if the patient qualifies for something higher end.

Examples of qualifying diagnosis for the higher end cushions are as follows: paraplegia, cerebral palsy, multiple sclerosis, hemi paresis, post polio, amputee, and pressure wounds. There are several other diagnoses that can qualify you.

The best way to determine that you are getting the correct cushion is come into Colonial Medical Supplies location and let one of our trained personal guide you through the many options.

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