1998 Medicare Payments for Concentrators Down $311 Million Baltimore-Oxygen concentrators topped last year's list of highest paying Medicare codes, but the $1.25 billion payout for the product was down from $1.56 billion the year before, according to statistics from the Health Care Financing Administration's Office of Information Services.

[See related chart below.]

The number of providers doing business with Medicare continued its decline, according to the National Supplier Clearinghouse. Medicare supplier numbers in use as of March 1999 fell to 108,523 from 116,834 in May 1998, which was down from 156,098 in May 1997.

Bill Focuses on New Providers Washington-A new bill before Congress would require mandatory site inspections and background checks for new home medical equipment companies before the National Supplier Clearinghouse assigns a Medicare billing number.

The legislation, sponsored by Sen. Richard Durbin, D-Ill., and Sen. Susan Collins, R-Maine, would turn some NSC initiatives into law. Currently, for example, site inspections and background checks are random, according to the senators.

The bill, backers said, is aimed at weeding out "bad apples" and should not be interpreted as a blanket indictment of HME providers. "Unfortunately," said a Durbin aide, "when you crack down on fraud, it tends to have an effect on the entire spectrum."

Bill Targets Appeals Process Washington-Rep. Bill Thomas, R-Calif., has introduced legislation to clarify and improve the appeals process for Medicare coverage decisions regarding lifesaving, life-enhancing medical technologies.

According to the Health Industry Manufacturers Association, an appeal to the Health Care Financing Administration Part B takes 557 days, on average.

The bill is designed to help expedite patient access to technological advances by imposing time frames for appeals that could cut the process in half. The bill also would establish new patient rights to external review of national coverage determinations.

Cuervo, Ladipo Expand Roles Alexandria, Va.-Now that management at the National Association for Medical Equipment Services has been pared, Asela Cuervo and Kathy Ladipo are assuming expanded roles, according to board chairman Mario LaCute.

Cuervo has been appointed vice president for legal and government affairs and Ladipo has been named manager for regulatory affairs. "Asela and Kathy have exemplified the kind of professionalism that NAMES expects to personify as we move forward," LaCute said.

Region D's Request For Clinical Data Sparks NAMES Involvement Alexandria, Va.- The National Association for Medical Equipment Services will investigate a potential change by the Region D Durable Medical Equipment Regional Carrier to require more than a certificate of medical necessity for reimbursement, according to Asela Cuervo, NAMES assistant vice president of regulatory affairs.

Bill McCullough, president of Western Rehab Systems, Benicia, Calif., told Cuervo his enteral claim was denied and a follow-up letter was termed "too slick" by the Region D medical director.

"He was very open with me, and he said he would need what he called 'contemporaneous clinical documentation,'" said McCullough. "I told him that's difficult for a home care company to provide, that it has to come from the physician. If they go this way, it's a very troublesome trend."