How You Can Do More for Less

Today's insurance carriers — Medicare, Medicaid and others — are making it increasingly difficult for health care suppliers to get paid for their services. No matter what service or equipment is supplied, payers are limiting the amount of reimbursement or making it more challenging to get reimbursed at all. And when you do get paid, you never know if Medicare will later decide to recoup the money during a post-payment audit. Knowing that the Medicare Modernization Act will continue to create allowable reductions makes the pressure even more intense.

The situation is frustrating to be sure, but there are some things you can do to counteract the rigorous requirements that continue to pester the industry.

More for Less

From order intake to accounts receivable, it is clear you will need to learn to do more for less. What does this mean? Invariably, you will have to expect more of your staff as Medicare requirements become more demanding. For example, when Medicare requires proof that your diabetic patient has actually been testing, will you have access to that documentation? Or will you take the chance that the DMERC may not actually ask for this backup proof?

Are you corresponding with your sleep therapy patients to determine if they are using their CPAPs (continuous positive airway pressure devices) between days 61 and 90 of the rental period? Is this documented for proof during an audit? In this strict reimbursement environment, contact your rental patients at regular intervals to establish whether they are still using the equipment. It is your responsibility, according to Medicare, to ensure that the patient is actually using and has a clinical need for your equipment.

In an effort to hone in on costs, consider using an intern to make your calls. There are also companies that make these compliance calls by computer. Ironically, for customers who don't mind computer-generated calls, this tactic works well because it cuts down on costs and can generate additional revenue in accessory/add-on sales.

Minimizing expenditures while achieving outcomes can be accomplished if you explore alternative ways of handling mundane tasks.

For example, do you employ a quality control staff/employee to review your intake documents before releasing claims? If so, how many control checks do you require internally? More than ever, in an effort to submit clean claims, HME providers are adding quality control checks to review their already-reviewed documentation. This becomes superfluous if you have too many checks and too many hands touching the work.