Archive: Feb 2015

  1. The Truth About Insurance Coverage for VAD Driveline Supplies: What You Need to Know

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     The Truth about Insurance Coverage for VAD Patient Supplies

    Decreasing the Risk of Financial Hardship for the VAD Patient at Home

     

    Medicare guidelines – In 2012, CMS made the determination that traditional DME companies could no longer bill dressing supplies for VAD patients and that billing entities must have a “carrier provider” designation.  Many DME companies do not know that the rules have changed and are still trying to bill some of the supplies.   If a Medicare audit indicates that a DME has been billing and receiving reimbursement for VAD supplies, Medicare will most likely ask for repayment.  Because such an event could cause a DME company to financially fail, the DME would likely bill the patient for the amount recouped by Medicare.

    Commercial insurance – Traditional DME’s can bill for VAD patients having commercial insurance or Medicaid. However, hospital reliance on an insurance company’s short list of in-network DME suppliers for outpatient driveline dressing supplies can be a costly mistake.  Unfortunately, insurance companies rarely know the limitations of their chosen and usually, long-standing DME suppliers. The truth is that traditional DME suppliers are often unfamiliar with the unique needs of VAD patients and many times will substitute ordered products for inferior ones or different ones.  This practice can ultimately put the patient’s health at risk.  Updates on new, possibly better-qualified in-network providers for outpatient supplies are not always available to the hospital.

    In many cases, insurance companies will see the need for a niche provider and allow it into their networks to provide services for unique patients such as those with a VAD.  A supplier company that has insurance company relationships and deals one-on-one with these companies daily can often convince a given insurance carrier to provide appropriate benefits and to even let them into network as a provider for future VAD supply claims.

    VAD facilities should seek a VAD-knowledgeable company that understands the unique needs of these patients and that will research each patient’s specific policy benefits and discuss them with the patient before sending out VAD dressings and supplies.  A knowledgeable company has the skill to advocate for the patient by fighting for patient coverage and the insurance carrier’s preauthorized, correct payment for VAD supplies.  This can reduce the chances for unexpected, exorbitant patient copays.

    Medicaid – Many DME companies do not attempt to become in-network providers in state Medicaid programs because reimbursements are not always sufficient and are slow to be processed.

      It is illegal for a company to provide products to Medicare patients withot billing for them.  This is considered an inducement and is deemed an unfair business practice under the law.  Patients should receive statements from their insurance provider showing that billing has occurred.  Providers are also required to make reasonable attempts to collect copay amounts

  2. Close Friend Helps Man Prepare for #VAD Implant

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    Planning Ahead for a #VAD planning ahead –

    Friends Raise Funds for Westfield Heart Patient

    Jill D’Ambrosio

    Saturday, February 14, 2015 • 9:28pm

    WESTFIELD, NJ – On Valentine’s Day, resident Doug Lynch has a message for the community: Please help in his effort to raise funds for his close friend, Dan Weiniger, a Westfield resident who is preparing for open heart surgery on Monday.

    On Friday at 5 p.m., Lynch launched a fund drive on GoFundMe.com to raise money to purchase a whole house generator to be installed at Weiniger’s Westfield home. The fundraising goal is $8,736. By Saturday afternoon, over $1,200 had been donated.

    The generator will provide a guaranteed source of electricity needed to recharge daily Weiniger’s new left ventricular assist device (LVAD), which will be implanted during Monday’s operation at Morristown Memorial Hospital. The LVAD will help Weiniger’s heart pump blood more effectively.

    In the last few years, the region has lost power several times for prolonged stretches due to hurricanes and an ice storm. For this reason, the generator is crucial to Weiniger’s well-being.

    “If the power goes out, it’s literally life and death,” said Lynch.

    To donate, visit http://www.gofundme.com/DanWeinigersLVAD.

    Fourteen years ago, Weiniger, now 53, underwent successful quintuple bypass surgery and was doing well until he suffered a heart attack last week, which caused severe damage to his heart.

    “Dan is now in heart failure, and another bypass is not an option. Neither are new drugs or stents,” reads the statement on GoFundMe.com.

    Lynch met Weiniger through Westfield’s chapter of Business Networking International, of which they have both served as presidents.

    Weiniger, who is married to Jan and is the father of 14 year-old Eliza, owns and operates Home Video Studio in Westfield, where he specializes in transferring VHS recordings to DVDs.

    “What he does is help families preserve their memories in a more permanent state,” Lynch said. “Dan is one of the kindest people I know.”

    Lynch, who owns A-1 Basement Solutions in Scotch Plains, said that Weiniger is in the coronary care unit at Morristown Memorial awaiting surgery Monday.

    “I consider it a great honor to do something for him,” said Lynch. “Also, I’d ask everyone who reads this to keep Dan in their prayers.”

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  3. Thanks, Dr. Guglin, for Your New #VAD Journal

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    New Journal Dedicated to Ventricular Assist Devices is Launched

    Released: 2-Feb-2015 4:00 AM EST

    Source Newsroom: University of Kentucky
    Newswise — LEXINGTON, Ky. (Jan. 30, 2014) — Maya Guglin, MD, PhD, Director of Mechanical Assisted Circulation at the University of Kentucky’s Gill Heart Institute, has launched The VAD Journal, a publication focused exclusively on mechanical assisted circulation.

    “Mechanical assisted circulation is the most rapidly developing area of cardiology, but there is no journal dedicated to papers in this area,” Dr. Guglin said. “The growing number of patients with heart failure, the limited pool of donors for cardiac transplantation, and several technological breakthroughs have all made the option of implanting a ventricular assist device as destination therapy more important, and therefore it’s essential to give cardiologists a dedicated forum to share their research and opinions on the topic.” A ventricular assisted device, or VAD, is an implantable device that helps the heart do its job when it is too weak or diseased to perform effectively on its own. Originally designed as a means to maintain circulation until a donor heart could be found, VADs are now gaining popularity as a destination therapy for patients with heart failure. The VAD Journal will be an open access publication, meaning that its content is available online without significant financial, legal or technical barriers. “We intend for the VAD Journal to be a forum where all subspecialties in the field of mechanical assisted circulation and advanced heart failure can share ideas and opinions,” Dr. Guglin said. “It was created with the purpose of enabling rapid dissemination of unbiased reviews of new findings and ideas for all interested parties.” The VAD Journal can be accessed athttp://uknowledge.uky.edu/vad/

  4. New Online VAD Journal Compliments of Dr. Maya Guglin

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    New Journal Dedicated to Ventricular Assist Devices is Launched

    Released: 2-Feb-2015 4:00 AM EST

    Source Newsroom: University of Kentucky
    Newswise — LEXINGTON, Ky. (Jan. 30, 2014) — Maya Guglin, MD, PhD, Director of Mechanical Assisted Circulation at the University of Kentucky’s Gill Heart Institute, has launched The VAD Journal, a publication focused exclusively on mechanical assisted circulation.

    “Mechanical assisted circulation is the most rapidly developing area of cardiology, but there is no journal dedicated to papers in this area,” Dr. Guglin said. “The growing number of patients with heart failure, the limited pool of donors for cardiac transplantation, and several technological breakthroughs have all made the option of implanting a ventricular assist device as destination therapy more important, and therefore it’s essential to give cardiologists a dedicated forum to share their research and opinions on the topic.”

    A ventricular assisted device, or VAD, is an implantable device that helps the heart do its job when it is too weak or diseased to perform effectively on its own. Originally designed as a means to maintain circulation until a donor heart could be found, VADs are now gaining popularity as a destination therapy for patients with heart failure.

    The VAD Journal will be an open access publication, meaning that its content is available online without significant financial, legal or technical barriers.

    “We intend for the VAD Journal to be a forum where all subspecialties in the field of mechanical assisted circulation and advanced heart failure can share ideas and opinions,” Dr. Guglin said. “It was created with the purpose of enabling rapid dissemination of unbiased reviews of new findings and ideas for all interested parties.”

    The VAD Journal can be accessed athttp://uknowledge.uky.edu/vad/