Industry Matters

In today's episode of Industry Matters, U.S. Rehab edition, Tyler Mahncke of U.S. Rehab discusses a new partnership between MK Battery and Rolko. By formulating this new partnership, U.S. Rehab members will now be able to order wheelchair parts through MK Battery, which is a cost and time savings for complex rehab providers. 

Welcome to Industry Matters, in today’s product spotlight, Adam Miller, president of OGPA talks with supplier partner TriOx  about one of their innovative products, ROSS.

Use code: OPGA2024, to receive a discount on ROSS. If you have any questions reach out to [email protected].

In today’s episode Heather Trumm, Director of VGM Wound Care talks with Linda Murray from Abbott Nutrition about the important role nutrition plays in wound healing and how a simple drink can help heal wounds. They talk about the different types of food groups to include, how much water is needed, and much more. 

Additional Resource: 

• Patient Education - Support Wound Healing Through Nutrition
• Juven Decision Tree
• Juven Sales Brochure
• Nutrition to Support Your Wound Healing Blog

In today’s episode Tyler Mahncke, V.P of U.S. Rehab sits down with one of the top complex rehab technology providers in the U.S. along with Dr. Viswanathan, Founder and CEO of Braze, as they share stories about the success of this growing smart technology for power and manual wheelchairs. We chat a bit about how this has impacted their businesses, how satisfied their clients have been, how this technology has protected the health and safety of their clients and lastly, Braden shares some personal stories about his father and how this technology could have helped lengthen his life had he had access to smart wheelchair technology. 

In today’s episode, VGM Live at Home’s vice president, Jim Greatorex talks with Rick Lair from Challenge Specialties about bank trusts and how they impact home accessibility clients and home modification companies. 

In today’s episode Tyler Mahncke, V.P of U.S. Rehab sits down with Caleb Polley, the CEO of Cubby Beds, one of the most innovative and fastest growing companies in CRT, as they share stories about the success of their life changing bed solution for children with special needs. We chat a bit about how Caleb got into the home medical industry, some of the hardships he had to work through early, how Covid may have created a tailwind in their business, the incredible features that their bed has, and even gives us a sneak peek into the future of the company.

In today’s episode, VGM’s Craig Douglas and Ronda Buhrmester talk about the importance of taking action to pass Bill S. 1294 which would extend the 75/25 blended rate from the Cares Act. Listen as they explain why this is necessary and what you can do to help!
 
Understanding the 75/25 Blended Rate and Why We Need Legislative Action!

In 2020, amidst the challenges posed by the COVID-19 pandemic, the healthcare industry witnessed the introduction of the 75/25 blended rate through the passage of the CARES Act. This rate adjustment, named after its 75% and 25% allocation model, aimed to protect access to DME products and services in non-rural, non-competitive bid areas by temporarily increasing Medicare reimbursement rates for providers serving those areas. Craig Douglas, VP of Payer and Member Relations, and Ronda Buhrmester, Sr. Director of Reimbursement and Payer Relations, recently released a podcast going into a deep explanation of the 75/25 blended rate and why keeping them in place is so important to the industry. In this article, we will highlight some of the key points around the 75/25 blended rate, its significance, its implications for the industry, and the ongoing legislative efforts to extend its benefits. 

Origins of the 75/25 Blended Rate 

The 75/25 blended rate emerged as a response to the COVID-19 pandemic with the enactment of the CARES Act in early 2020. This legislative action was designed to ensure that medical equipment suppliers could continue providing essential services despite the challenges posed by the pandemic. The "75/25" in its name refers to the proportion of reimbursement rates calculated from two different periods: 75% from the post-competitive bidding rates and 25% from the unadjusted fee schedule in place before competitive bidding. This blended rate was implemented to counter the decline in reimbursement rates experienced in the years leading up to the CARES Act. 

Understanding the Blended Rate Calculation 

To grasp the concept of the 75/25 blended rate, let's consider an illustrative example with a CPAP device (HCPCS code: E0601). Prior to competitive bidding and rate adjustments, the reimbursement for this device was approximately $100. Through various rounds of competitive bidding, the reimbursement rate saw a substantial reduction to around $40 by 2020. The blended rate calculation takes 75% of the lower 2020 rate (75% of $40) and 25% of the pre-competitive bidding rate ($100), yielding a blended rate of approximately $55 for most non-rural areas. 

Extension Efforts: Senate Bill S.1294 

The 75/25 blended rate significantly impacted the reimbursement landscape for specific medical equipment codes, particularly those that experienced substantial decreases due to competitive bidding. This adjustment aimed to ensure that suppliers could continue providing essential medical equipment to patients while maintaining financial sustainability. 

However, the 75/25 rates are not permanent; they are currently slated to end on 12/31/2023. When this happens, those rates will revert to what was in place prior to the implementation of the 75/25 blend, adjusted for inflation. This will mean a decrease in reimbursement of up to 40% for many DME products provided to non-rural, non-CBA beneficiaries. Click here to view a chart with examples of what the impact will look like for several high-utilization products.

Click here for more information on MLNs in this CMS article.

For more information and to take action read this article.

In today’s episode Boone Lockard, Director of VGM Respiratory talks with Encore Healthcare and MedSouth Inc about their partnership and the positive outcomes MedSouth Inc has seen using Encore’s Nexus Software and Program. You won’t want to miss this amazing story of how MedSouth Inc is changing people's lives. 

In today's episode, Mandi Joyner, Senior Director of Marketing at VGM & Associates. talks with 3 of our payer, billing, and reimbursement experts; Ronda Buhrmester, Dan Fedor, and Craig Douglas about the end of the Public Health Emergency, or PHE and what that means for our members. Thank you all for taking time out of your hectic schedules to discuss this important topic. 

In today's episode of Industry Matters, Mandi Joyner discusses all things wound care with the Director of Wound Care, Heather Trumm, and Ronda Buhrmester, Sr. Director of Payer Relations and Reimbursement. They walk through billing, intake, wound care categories, and much more!