Industry Matters - Powered by VGM

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!

In today’s episode, Adam Miller, president of OPGA, talks with Jeff Brandt, of Brandt Ventures, about the  Limb Loss and Preservation Registry and the progress they’ve seen in the last year. They discuss the importance of the outcomes program in providing evidence-based care in the O&P profession.

In today’s episode, Mandi Joyner, Senior Director of Marketing for VGM & Associates, as well the Marketing Pillar for Heartland Conference talks with other members of the Heartland Conference planning committe about what to expect for 2023! She is joined by Jill Blaser, Heartland Chair; Kayla Mahler, Education Chair; and Samantha Doering, Events Chair. 

In this episode of Industry Matters, Alan Morris, Director of Research and Strategy for VGM Government Relations, and John Gallagher, VP of VGM Government Relations, talk with Brian Leitten from Leitten Consulting, about a new study, "OIG Recommends 'High Risk/Low Reward' Strategy on Intermittent Catheters." The study looks at concerns and costs associated with reducing access to urinary catheters. 

In today’s episode, Ronda Buhrmester, Sr. Director of Payer Relations and Reimbursement for VGM Government Relations, and Mandi Joyner, Sr. Director of Marketing, finish up their three-part series. In this final episode, they talk about billing the claim, HCPC Codes, modifiers, and avoiding some audits.

In today’s episode, Ronda Buhrmester, Sr. Director of Payer Relations and Reimbursement for VGM Government Relations, and Mandi Joyner, Sr. Director of Marketing, continue their three-part series. In this second episode, they talk about medical records, delivery, and ongoing need, including drop-shipping and remote setups. 

In today’s episode, Ronda Buhrmester, Sr. Director of Payer Relations and Reimbursement for VGM Government Relations, and Mandi Joyner, Sr. Director of Marketing, kick off a three-part series. In this first episode, they talk about the intake process and ordering and how to help make this process as smooth as possible.

In today’s MUST listen to the episode, Mandi Joyner, Senior Director of Marketing,  talks with Ronda Buhrmester, Senior Director of Payer Relations and Reimbursement for VGM Government Relations, and Kelly Grahovac, General Manager for the van Halem Group, about how the Mississippi River is playing a role in the changes to the DMEPOS provider enrollment and what, if anything, you need to be doing. Helpful Links:Medicare revalidation list: https://data.cms.gov/tools/medicare-revalidation-listNPE West: https://palmettogba.com/palmetto/npewest.nsfNPE East: https://www.novitas-solutions.com/webcenter/portal/DMEPOSSite visit checklist: https://www.palmettogba.com/palmetto/nsc.nsf/DIDC/AFQLMT4106~Supplier%20Enrollment~Standards%20and%20Compliance

In today’s episode, Jim Greatorex, VP of VGM’s Live at Home talks with Gabrielle Welter, Strategic Business Development Manager at AAG. They talk about how people can use reverse mortgages as funding resources for home accessibility projects.   

In today’s episode of Industry Matters, Miranda Murphy, with VGM Therapy speaks with Greg Guinter, the Director of Therapy and Rehab Sales for Medline. They talk about the changing landscape of healthcare, the challenges healthcare systems are facing as they relate to physical therapy, occupational therapy, and speech therapy service providers, and the evolution of innovation and technology in the therapy space. They will be discussing ways to help you find solutions.  

In today’s episode of Industry Matters, Mandi Joyner, Senior Director of Marketing  for VGM & Associates, talks with Nikki Jensen, VP of Essentially Women, the women’s health division here at VGM. They are talking about the launch of the new Lily Program. 

In today’s episode of Industry Matters VGM & Associates' Mandi Joyner, Senior Director of Marketing and Communications, talks with VGM’s Ronda Buhrmester, Senior Director of Payer Relations and Reimbursement about CMNs, LCDs, CPAP Policy changes, National Coverage Determination...in short, helping you understand how to get paid faster and keep your money. Ronda, thank you so much for being here today, please introduce yourself.  

In today’s episode of Industry Matters Boone Lockard, Director of VGM Respiratory talks with Chief Commercial Officer for Trace Medical, Elliot Campbell about Trace Medical’s history and growth to the ventilator rental company in the U.S., how they navigated COVID-19, and why you should be looking to Trace Medical to help optimize inventory, take advantage of asset flexibility, and increase EBIDTA margins.

In this episode of Industry Matters, John Gallagher, VP of Government Relations and Mark Higley, VP of Regulatory Affairs for VGM & Associates talk with Brian Leitten, CEO of Leitten Consulting about a recent study looking at three additional categories for building a case for additional Medicare and Medicaid investment.  Read the Full StudyVisit VGMGOV.com

In this episode of Industry Matters we continue our series for our OPGA community. In this edition of “Women Leaders in O&P,” Ashlie White, OPGA’s O&P 2021 Woman of the Year and Director of Health policy and Strategic Alliances for AOPA, talks with Kelly Gies, COO and Partner of Cornerstone Prosthetics and Orthotics. They discuss the importance of data and analytics, cost indexing, insurance contracts and if they are helping your business be profitable, and much more. 

In this episode of Industry Matters Barry Thwaits, VP of Business Development for VGM & Associates talks with Adam Clark, Business Development Consultant for Post-Acute Care at Philips about long-term and post-acute care opportunities for providers. They analyze the business opportunity, reimbursement, and the resources needed to get into this growing market.  

In this episode of Industry Matters, OPGA president, Todd Eagen, talks with Dr. Kenton Kauffman of the Mayo Clinic about the Limb Loss and Preservation Registry. They discuss the importance of the outcomes program in providing evidence based care in the O&P profession.