Dare to Soar

The majority of my life is spent on airplanes visiting HME providers throughout the United States, Puerto Rico and the Virgin Islands. As I fly from place to place, I see many similarities among these providers. The primary attribute I always notice and admire is the love and care that they give their patients. Most independent providers started their companies because of a personal experience with a loved one, or the love they have for helping others. Does this change just because a few laws change or reimbursement is cut? Absolutely not!

New provisions in the Medicare Prescription Drug, Improvement, and Modernization Act, have made this a time of uncertainty for the home medical equipment industry.

But HME providers have experienced many ups and downs through the years, and regardless of the obstacles, most have continued to fly strong. Now is the time to stay in this industry-and grow stronger than ever.

Take a close look at your business. Write a plan, including policies and procedures on how you intend to streamline your billing and intake departments — as well as your entire company. By focusing on accounts receivable (A/R), you will be amazed at how much your business can improve, even in difficult conditions. How many HME owners truly know how to work A/R and denials? Not many! To start, consider the following:

1. Work denials in a timely manner — Denials must be worked within 120 days from the date of receipt on the EOB (explanation of benefits). You must have a written policy and procedure stating that your company will work denials within 72 hours from the time they are received in your office. More importantly, follow up to ensure those denials have been worked. Education is always needed in the denial department. Make sure employees are not just re-transmitting all denied claims again and again. Teach employees how to work each and every denial code.
2. Work accounts receivable efficiently — Your best biller should be the person primarily responsible for making sure your A/R is worked effectively. Set goals and timelines for each insurer and employee. Because each A/R is worked differently, print each one separately. Print Medicare primaries and secondaries together, Medicaid, patient portions, and then print each insurer. Your employees should be able to mass-print all outstanding secondaries to get them in the mail or transmitted quickly. Always follow up daily on what has been assigned to each employee. Remember that when you are working denials, you are working A/R.
3. Educate the billing department — Take the time to educate your billers to bill out the claims correctly the first time. The No. 1 excuse I hear from providers is, “I do not have the time to train.” In reality, you do not have time to ignore training. Billers must know the documentation and qualification guidelines as well as understanding modifiers and how to apply them appropriately. HME is a very regulated industry, so you must be certain that your billers are doing the right thing. This will save an enormous amount of money and time.
4. Educate intake personnel — Everything is not the biller’s fault. If information is not obtained correctly at intake, it affects the company’s entire operation. Intake personnel decide whether a patient qualifies for the equipment and supplies ordered, so these employees should be educated as thoroughly as staff in the billing department. Unfortunately, this usually is not the case. Make sure your company’s intake form is user-friendly and gathers all of the information necessary to deliver the equipment. Audit your intake department and determine methods to streamline your operations here as well. And if you are considering cutting employees to save money, think about whether you really want to reduce staff when they can be utilized to collect your A/R, market more effectively or provide more efficient intake and insurance information.
5. Audit monthly — How many of us audit our companies monthly? If we did, we could catch our errors and correct them prior to the following month. To check how you are doing, pull 15 patient files at random every month.

First, ensure that Certificates of Medical Necessity are complete, correct and transmitted as a “mirror image” of the paper CMN. Make certain you have supporting documentation as required by policy.

Second, audit all items requiring a “KX” modifier. Since KX modifier items are subject to frequent audits, you should have everything on file before transmitting items with this modifier.

Third, audit Written Orders Prior to Delivery (WOPD) items. These include power-operated vehicles (scooters), TENS units, seat lift mechanisms and all decubiti ulcer items. Since these cannot be appealed, you must have a policy ensuring that you have a WOPD on file before the item leaves your showroom or warehouse. The WOPD can have a faxed or an original signature.

As you can see, there is a lot providers can do to save money, keep the money received and increase revenues. By obtaining insurance verification, providers will reduce the amount of equipment for which they are not reimbursed. And by training effectively throughout the company, everyone benefits.

I understand that some providers may be fearful of the future. With reimbursement cuts coming and policies changing, I have heard some providers say, “We are going to cut staff.” Or, “We are going to have to do less for our patients.” Or even, “We are just going to sell.”

But these are not the answers. Do not make hasty decisions based on what might happen in the next few years. With the increased number of beneficiaries over the next five years, what better industry is there?

Let’s dare to soar, and grow together in 2004.

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].