Is there a market to outsource HME management to hospitals?

YES, BUT TODAY it is a small and growing niche of the market. Of the 6,097 hospitals in the United States, an estimated 20 percent have a home medical equipment program in place, (based on Cherney & Associates market research). Only a minor percentage of these (less than 5 percent) have management agreements for HME because there has been little effort by the industry to put these kinds of agreements in place. The upside to these agreements from the hospital perspective is that they can most often increase their business significantly because community-based providers have generally done a better job at marketing. The hospital should also be able to save in its management expenses. Hospital senior executives are increasingly interested in outsourcing their services so they can return to their core businesses. Hospitals outsource everything from dietary departments to emergency rooms, and a large number of them outsource home health agency management.

-Answered by Alison Cherney, president of Cherney & Associates, 9719 Concord Pass, Brentwood, TN 37027; 615/776-3399; fax: 615/776-3492; e-mail: CherneyAJ@aol.com; Web site: cherneyandassociates.com

I am confused about all of the date fields on CMNs and how they affect my claim. DMERCs want the doctors to sign CMNs within 30 days. How am I going to do that without my claim denying all the time?

THERE ARE MANY important dates on a certificate of medical necessity, and you need to understand what those dates mean and how they may be used to draw comparisons with other dates on the same CMN. One in particular is the "initial date." This is a date filled in by the supplier. Historically, this is the first service date for a specific item for a specific patient. However, it could also be before the actual service date if necessary. Some recent controversy has come up with regard to what should go in that date field. I have heard of an ombudsman for a Durable Medical Equipment Regional Carrier who told suppliers that this date should be the first time a supplier is made aware that a patient may need an item-which could be a month before services are rendered. It is important to note that this date field is the date that starts the capped rental clock that counts the months on rent. If you put a date in the "initial date" field prior to your actual first service date, you risk starting the capped rental clock before you even get paid for your first rental month.

Regarding physicians: The essence of the DMERCs' position is that the physician must sign the CMN in a timely manner. However, the only person who bears the burden of an untimely physician signature is the provider who cannot control the physician's behavior. I could list numerous scenarios where an untimely physician signature is completely outside the control of the provider, yet the DMERC wants to put the provider at risk. It is important to point out that this issue, as raised by the DMERCs, has not survived the test of the Health Care Financing Administration. The Health Industry Distributors Association had raised this issue with HCFA and is asking for clarification to support the DMERCs' position. In the meantime, I suggest that you continue to try to obtain complete and accurate CMNs from physicians in the most timely manner possible.

-Answered by Lisa Thomas-Payne, MRS/MedSource LLC, 4665 Indian School Road N.E., Suite 112, Albuquerque, NM 87110; 505/255-0004; fax: 505/255-0550; e-mail: lthomasp@aol.com