Garbage In, Garbage Out

Providers are searching for ways to survive the cuts in reimbursement, streamline their operations and continue to serve patients as they have in the past. Start with your office and examine your company’s intake processes.

For HME intake, the adage applies: Garbage in, garbage out! While it is vital that employees are trained in the proper procedures, intake is more than answering a telephone and putting information down on paper or entering it into a computer system. The intake coordinator needs to understand what it takes to ensure you have all of the information necessary to deliver equipment and bill the claim in a timely manner.

Remember that it is just as important to educate your intake personnel as your billing and accounts receivable personnel. The first impression a referral source is going to have will come from the person who answers your phone. I have heard an intake coordinator yell, “Do we sell oxygen? Do they need a prescription?” Do you think a referral source who hears something like that will trust your company to set up oxygen for their patients? I don’t think so.

Accept that it may take more than one telephone call with the initial referral source to obtain all of the necessary documentation. Go that extra mile and call everyone you can until you have the information you need. Other health care providers do, so why don’t you?

Review your intake form to make sure it asks for all of the required information, including:

• Patient’s full name, as it appears on the insurance card
• Patient’s delivery address
• Patient’s “permanent” address. For this, ask patients where they receive their Medicare checks. This may be different than the physical delivery address. It will determine to which DMERC you bill the claim and should decrease your PR-109 denials (billing an inappropriate carrier or the patient is in a skilled nursing facility).
• Patient and emergency contact’s telephone number(s) and all pertinent contact information
• The primary insurance policy number and any secondary insurance information, including telephone numbers for insurance verification
• Treating physician’s name, address, telephone and fax, and UPIN information
• Equipment and/or supplies being ordered for this patient. Make sure you understand what is being ordered, the quantity and all of the relevant information for that particular piece of equipment.
• The date of discharge, if applicable. This is very important for patients who are in the hospital or an in-patient facility. If you deliver equipment to a patient in the hospital for training purposes, you have 48 hours from the date of discharge to bill that claim using the discharge date.
• Date of birth for the patient and, if different, the insured
• Social Security number
• Diagnosis qualifying the patient for the equipment and/or supplies ordered. This is vital to ensure you are not delivering equipment that is not going to be covered. Be very careful with the ICD-9 coding. Remember, there are numerous coding changes, and the grace period for providers has been eliminated.
• Length of need. This is very important with equipment that can be rented toward the purchase price. The National Supplier Clearinghouse 21 Supplier Standards state that a provider must give the patient the right to rent or purchase equipment in the “IR” category (inexpensive or routinely purchased items in the fee schedule). If the length of need does not constitute a purchase but you bill it as a purchase, you will owe the DMERC back for the remainder of that reimbursement. For example, if a bedside commode length of need is two months, it does not meet the guidelines as a purchase.

Other required information should be on separate intake forms for each category of equipment or supplies to ensure that the correct questions are asked. If you specialize in any particular categories, then add those questions necessary to the intake form.

Dusting off your intake process can be the first Band-Aid in your survival kit for doing business in the new reimbursement climate.

Jane Bunch is CEO of Kennesaw, Ga.-based JB&CS. A reimbursement specialist, Bunch delivers educational seminars worldwide, helps develop corporate compliance plans, and serves as a consultant for fraud and abuse cases. She can be reached at 678/445-1221 or via e-mail at [email protected].