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In most of the cases that weve seen, insurers will initially only approve TENS for a two-month trial period. Modern TENS technology, in use since the 1970s, operates on the same basic principle of applying electricity to areas of pain via percutaneous electrodes. What are the Side Effects of IFC, TENS, NMES? I paid the copay . Section, WaxWel Paraffin Bath - Standard Unit Includes: 100 Liners, 1 Mitt, 1 Bootie and 6 lb Unscented Paraffin, Baseline Plastic Goniometer - HiRes 360 Degree Head - 12 inch Arms. A TENS unit must be distinguished from other electrical stimulators (e.g., neuromuscular stimulators) which are used to directly stimulate muscles and/or motor nerves. How to Set NexWave for Optimul Stimulation? Private insurers also use the HCPCS codes, although they arent bound by CMS fees. This is excellent for pain relief if used as directed. This year, Zynex is expected to generate over $30M in supplies revenue (up 25% y-o-y). This is great and now one of the leads wont work. Insert the lead wires (black and grey) in the area located on top of the device. That no other public medical device company operates with a similar high margin reseller model for the overwhelming majority of its revenues should prompt questions from Zynex shareholders and it could also draw the attention of regulators. We became aware of the situation through a lawsuit filed by the competitor. For more, please visit https://themedichannel.com/zynex-nexwave-tens-unit-review/ This video reviewes the Zynex NexWave TENS Unit. Days sales outstanding (DSO) increased sequentially by 17% to over 60 days, its highest level in over four years. Yes, Zynex sells these same units online, an any needed supplies for less than rental costs. Also, the fact that no other companies have aggressively stepped in to fill the void (besides Zynex) makes the idea of an unfavorable TENS market even more believable. TENS devices are classified as Durable Medical Equipment (DME) by CMS which assigns Healthcare Common Procedure Coding System (HCPCS) codes and reimbursement fees for every DME covered by Medicare. What is IFC, NMES and TENS? Electrodes. This features, is very well made and it does everything it says it does. I wrote this article myself, and it expresses my own opinions. I wrote this article myself, and it expresses my own opinions. Follow these steps for the best outcomes. Lots of Bait & Switch goes on with this deal. Two months after the new TENS policy went into effect in May 2021, UHC began denying the claims for improper coding as Zynex was still billing with the "unbundled" electrodes HCPCS code A4556 rather than one or two units of the supply pack using the "bundled" code A4595. Thats why my physical therapist sought solutions other than drugs to help relieve my pain and build up my atrophied muscle. It's important to remember that before Zynex began its rise from an OTC penny stock in 2017, its underlying business was so weak that it was on the edge of bankruptcy under the weight of a $3m line of credit [Pg. The workers' compensation market might be the last area where the TENS business is feasible, due to an arcane and poorly controlled reimbursement and coding framework. If Zynex is in fact billing properly, we would expect competition to enter the space soon, pressuring margins. Although both are subject to review and recovery, the $115.62 for 6 units of A4595 ($19.27 each) is the best case for Zynex going forward - an 80% reduction in the rare case UHC pays a claim without review. However, the companys revenues reveal a business model increasingly vulnerable to competition and/or regulatory scrutiny. Entering text into the input field will update the search result below. According to the company, patients use NexWave for an average of six to nine months. Hence, consequently, its therapeutic effects. This can be connected to a wall charger, power bank or laptop usb port to charge. Even the slightest hint of Medicare or private insurers pushing back on Zynexs current reimbursement rates would re-price shares at the lower-end of peer multiples, in our opinion. Transcutaneous Electrical Nerve Stimulation. So, Zynex is capturing ~90% margins on 80% of its revenues for simply reselling standard batteries and electrodes. Even if we are wrong, and Zynex billing practices are industry standard and sustainable, competition would enter the TENS market given the ~90% gross margins on supplies, cutting profitability. Earlier this year, the stock was uplisted to the Nasdaq Capital Market. This allows us to use it for 2 different body areas, or by 2 people simultaneously. It has a Timer built-in for easy regulation. He's likely referring to an increased share of the workers' compensation market, which pays TENS claims at levels far above average. Current outstanding share count is 34M, of which 1.5M are options with strike prices below $1. It would be surprising if private rates were so much higher (over five times higher in this case), especially for a category like TENS, given its widespread usage and dated technology. 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Due to the egregious level of the overpricing during a time of increased focus on rising healthcare costs, we would not be surprised to see insurance companies begin to examine their reimbursement rates to Zynex in the near term. How does it work? Operating margins, negative to slightly better than flat in the years prior, jumped to 38%. Despite the risks inherent in Zynex, the companys market capitalization has soared 70x in the past 2 years. After two months, concerned about their co-pay obligation the patient reported the excessive quantities to UHC which flagged the patient's file and led to denials of 4 of 8 submitted claims. It is a device that incorporates IFC, TENS, NMES as unique all in one unit. Best Liquid Meal Replacements For The Elderly, Stanley Wanderguard Bracelets Review Wanderguard BLUE Tag vs. Wanderguard BLUE Wearable. Please. More companies exploiting this pricing inefficiency would increase the chances of insurance companies and government agencies re-examining reimbursement rates. Zynex was founded in 1996 by current CEO Thomas Sandgaard. UHC and workers' comp propped up an otherwise limp, money losing business. Weve reached out to CFO Dan Moorhead with our concerns and questions but have yet to hear back. It is a medical manufacturer of electrotherapy products for pain relief and management. A copy of a form that your doctor needs to fill before faxing over directly to the Zynex headquarters is downloadable from the website.Note, however, that after prescribing this device for you, it is not mandatory to use it only in the hospital under supervision. Zynex: Abusive Pricing Model Unsustainable - Seeking Alpha Nestle Nutren Optimum vs Nutren Diabetes How You Should Choos? On the surface, Zynexs (NASDAQ:ZYXI) model of selling electrical stimulation devices and supplies at high margins with technically little direct competition appears to be an attractive opportunity. Are Premier Protein Shakes Good for Diabetes? Amazon.com: Zynex Electrodes Therefore, medical devices that incorporate technologies such as neuromuscular electrical stimulation (NMES), interferential current (IFC) or transcutaneous electrical nerve stimulation (TENS). Best Weighted Blankets for Fibromyalgia Are Weighted Blankets Good for Fibromyalgia? Proven alternative for safe, effective home traction See product NMES E-Wave Easy-to-use NeuroMuscular Electrical Stimulator with unique features designed for high performance and a wide variety of options See product Stroke Rehabilitation NeuroMove A copy of a form that your doctor needs to fill before faxing over directly to the Zynex headquarters is downloadable from the website. We find UHC recently changed its TENS coverage policy which may lower its payments to Zynex by 80% - equivalent to 40-100% of 2021 EBITDA. While it was able to generate profits for several years, cash management was a recurring issue, and Zynex eventually found itself in default of a $4M line of credit by 2014 (10-K, page 12). If the stock weren't about to be crushed fundamentally, it will nonetheless be pressured by CEO Thomas Sandgaard who is selling stock to meet his significant cash flow needs. Zynex is essentially conducting an arbitrage between its suppliers and price insensitive (for now) insurers. Seeking Alpha's Disclosure: Past performance is no guarantee of future results. Zynex stock went from $0.10 in 2016 to nearly $30 in 2020. Sometime in 2017 it appears Zynex was able to negotiate a nonsensical quantity of electrodes per patient - 64 pairs per month, a figure we confirmed with UHC employees and patient claim forms. But even assuming Zynex unbundles batteries and electrodes codes, we cant get to $1,200 for supplies or $1,500 total in our hypothetical scenario. Its noteworthy that Zynex doesnt hold any patents for NexWave, likely because its based on technology that is several decades old. How does Zynex arbitrage its generic supplies manufacturers and private and public payers? Using Medicare's fee schedule, our estimate of commercial insurance reimbursement and our work on UHC, we estimate reimbursement by payor and worker's comp orders which we think lie somewhere in the middle: Exhibit 9 - Estimated average reimbursement per order by payor. Zynex primarily markets NexWave, a transcutaneous electrical nerve stimulation (TENS) device indicated for the management of chronic intractable pain, post-traumatic and post-surgical pain. Evidence supporting TENS efficacy is mixed and inconclusive mainly due to a lack of randomized controlled trials. Then, beginning in 2017, supplies suddenly accounted for 80% of revenues and has remained at those levels since. Then out of nowhere the business improved. For supplies, Zynex should be using code A4595 which includes one month of supplies for a 2-lead TENS unit. This give it a try, is the most effective and it is super sticky. If so, Zynex will eventually have to write-down accounts receivable and restate earnings. This is much safer, it will for excellent value and has a compact design. We believe this includes two batteries and two 4-packs of electrodes. Sandgaard claims the upswing was the result of increased market share after the exit of two large competitors. At Q1, Zynex reduced its salesforce to under 500, but still expected 600 by year-end. This is very powerful and can only go to level 5. I have no business relationship with any company whose stock is mentioned in this article. 16], we think UHC may account for only 2-5% of orders, but 10-25% of revenue. We acknowledge there is no shortage of controversial pricing examples in healthcare, but from what weve seen, other examples involve at least some level of innovation they dont involve companies essentially acting as a distributor of generic, household supplies. I am not receiving compensation for it (other than from Seeking Alpha). Below is a screenshot of part of our complaint to the OIG. Medicare and private payers have strict guidelines for how TENS is covered. Recall 80% of revenues now comes from supplies, so roughly $300 is collected for the device and $1,200 from supplies over the course of six to nine months, on average. Zynex shares are up ~100x since late 2016 as retail investors buy into a story of rapid revenue and earnings growth. How to Set NexWave for Optimul Stimulation? For NMES treatment, press the NMES button. You may also contact Patient Enrollment at (720) 912-1972 or PatientEnrollmentMail@zynex.com to complete your order. Shop products from small business brands sold in Amazons store. Exhibit 4 - 640 pairs of electrodes received by UHC patient over 10 months. An increased share of workers' comp patients and the new opportunity to dump massive quantities of electrodes on UHC patients led to major shifts in the company's financials: supplies rose to 79% of revenue in 2017 after averaging 39% between 2009 and 2016 (Zynex breaks out revenue for devices and supplies). The fundamental blow couldn't have come at a worse time for Zynex whose CEO is forced to sell shares to meet his significant personal cash flow needs. Investors saw a rapidly expanding, profitable company with no significant competition. We think the end is in sight. Click here We're hiring Visit Our Career Page to Learn More In an open-label study, these researchers examined the effect of short-term PNS on individuals with PNP due to . When Should You Not Use Zynex NexWave? We think the large receivables and DSO increases are at least partly due to lower collections from UHC, and that Zynex hasn't yet changed its revenue assumptions to account for the policy. What are the Features of Zynex NexWave? For the first two months, Zynex can typically bill insurance using either of HCPCS codes E0720 or E0730 (with a modifier denoting the device is rented). Otherwise, there is nothing unique about the batteries or electrodes (the electrodes are manufactured by Axelgaard). This comes with pain reliever, is very big and it allows for a nice storage bag. That's very much a negotiating item and by being able to negotiate well and make sure that the patients get the supplies that they actually need.". Days sales outstanding rose to highest level in over 4 years. We identify UnitedHealthcare as Zynexs largest payor and estimate it was paying ~7x more per order relative to other commercial insurers, artificially sustaining the weak underlying business. Remember the story of David narrated at the beginning of this article? Glucerna Or Nutren Diabetes What Is Best For Diabetics? The codes aid in billing standardization and data collection. Injuries, muscle atrophy and other pain-inducing conditions often make one depend on opioids, muscle relaxants, over the counter drugs (OTC) etc.

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