2004 Reimbursement Survey

To remain profitable in the new Medicare era — with closer scrutiny of K0011 claims, slowed payment of non-HIPAA-compliant claims (which CMS says soon it won't accept at all) and coming cuts across a string of bread-and-butter products in 2005 — it's more important than ever that claims are clean and that reimbursement practices are efficient.

To find out where home medical equipment providers stand in denials and appeals, days sales outstanding (DSO), staffing and more, HomeCare fielded the magazine's annual reimbursement survey — our fifth — to a randomly selected group of domestic subscribers asking about their reimbursement procedures. Providers of all types and sizes responded, and the results of this year's survey are based on answers from 281 of your peers throughout the country.

The largest group of respondents (30 percent) told us their organization is a “full-service HME,” while 22 percent said their companies offer respiratory therapy and another 21 percent said they provide DME only. The majority of respondents (54 percent) reported annual revenue of $1 million or more, while nearly 42 percent reported revenues under $1 million. The average revenue of participating companies falls just under $2.7 million.

While some of the answers to our 32-question survey follow general historical trends, others reveal areas where providers can improve — and improve they must, according to Miriam Lieber, president of Lieber Consulting and a specialist in HME operations management and reimbursement. To help understand how fine-tuning reimbursement practices can increase profitability, we asked Lieber to review the survey findings.

“Reimbursement has always been a priority in every HME provider's operation,” Lieber says. “The difference today is that every move you make in this area is critical. You need to have strict policies that adhere to Medicare regulations, and you must tightly control and monitor them. You have to make sure that what you do today will not cause CMS to come back and recoup later.”

However, she continues, “you also have to run a business, and you can't lose sleep over every little detail. You need to follow the rules, but you shouldn't have to check them five times because then you lose profitability.