New Products and Industry News

NAHC comments on LMRP wound care draft

   Cahaba Government Benefit Administrators (GBA), one of four fiscal intermediaries for Medicare, issued a draft local medical review policy (LMRP) entitled, "Wound Care for Home Health." The National Association for Home Care (NAHC) submitted the following comments on the draft.

   According to the draft policy, Medicare coverage for wound care on a continuing basis would be contingent upon documented evidence that the wound is improving in response to treatment provided. If the wound does not improve after 3 weeks of a specific therapy, a new approach is required. The NAHC says wound healing is contingent on factors other than what is ordered and that some wounds never heal; wound care may prevent further deterioration and complications.

   Also, the LMRP draft contained a list of ICD-9 codes that support the medical necessity of wound care coverage. The NAHC commented that limiting ICD-9 codes may exclude wound care coverage for beneficiaries for whom wound care would be reasonable and necessary.

   The draft LMRP lists documentation requirements for wound evaluation, including secondary factors such as previous treatments and support systems for compliance with treatment, exclusive of that provided by the home health agency. The NAHC says these documentation requirements are excessive and exceed HIM-11 requirements and other CMS guidelines. Plus, a patient is entitled to have reasonable and necessary services reimbursed by Medicare without regard to whether someone is available to furnish the services.

   Under the LMRP, coverage of therapists performing home health care would be dependent on the therapists' specific scope of practice formulated by each state. The state law authorizing the therapist's scope of practice must include the specific wound care procedures permitted. The NAHC comments that most states' practice acts do not contain the level of specificity required by the LMRP; thus, the interpretation may limit the wound care coverage for some Medicare beneficiaries.

   Finally, under the LMRP, wound care will not be covered when performed by a therapy assistant. The NAHC notes that if wound care falls within the role of therapy assistants under the state practice acts, local medical review policy should not restrict this role.

   To obtain more information about the Cahaba draft wound care LMRP and other draft LMRPs, visit www.DRAFTlmrp.net/policy.asp.

Coding update available

   3M Skin Health Products (St. Paul, Minn.) has made available the HCPCS Codes (Medicare Part B), updated with Medicare's 2002 Fee Schedule for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. The information can be found at https://www.3m.com/us/healthcare/professionals/skinhealth/jhtml/reimbursement_guide.jhtml.

Hemostatic technology approved by FDA

   Medafor, Inc. (Minneapolis, Minn.) has received regulatory clearance from the Food and Drug Administration (FDA) to market its technology as a topical hemostat for the local management of bleeding wounds. TraumaDEX™ has been cleared for use by doctors and medical services' personnel for temporary control of severe bleeding in a variety of trauma and post surgical wounds. Bleed-X™ has been approved for over-the-counter use for cuts, lacerations, and abrasions. Both are based on Medafor's Hemadex™ technology - a biopolymeric, microporous powder that produces rapid hemostasis in areas of profuse bleeding. When applied to a bleeding wound site, the particles initiate coagulation within seconds, acting as molecular sieves to absorb fluids in the blood, attract and concentrate proteins and platelets, and accelerate the natural clotting cascade.

   To learn more about Hemadex and its benefits, visit www.medafor.com.

Senator and aide acknowledged for long-term care efforts

   The National Association for the Support of Long-Term Care (NASL) honored U.S. Senator John Ensign (R-Nev.) and his health aide, Aaron Cohen for their work in spearheading a Congressional initiative to repeal the $1,500 outpatient limit on therapy provided to Medicare beneficiaries. Senator Ensign's actions gained wide attention and a number of interested supporters in the House and Senate for this improvement. The limit on therapy was imposed in 1997 as part of a number of Medicare reductions. The NASL has documented that one out of seven Medicare beneficiaries in skilled nursing facilities routinely exceed this cap.