Is Retail the Answer?

When you are fed up with the burden of working with Medicare, Medicaid and other third party payers, where do you turn?

For many home medical equipment companies, retail is the answer. The idea of collecting cash up front is wonderful compared to completing the documentation required for third-party billing. For some, cash collections may mean meeting payroll. Moreover, it is far easier to train a retail clerk than to train a biller and a collector. So, why doesn't everyone add retail to the business mix?

From a practical perspective, many people do not turn to retail because the retail business is more difficult to operate than it appears. Why? Not only must retail salespeople have professional and courteous appearances, they also must be able to think on their feet and quickly provide third-party requirements — while still abiding by the same rules and regulations as everyone else.

For instance, front-end retail sales staff must understand Medicare documentation guidelines, how and when to use the Advance Beneficiary Notice, other third-party payer matters, and Health Insurance Portability and Accountability Act privacy protocol.

Retail and Medicare

If the retail department is busy at all, it usually is flooded with customers, each of whom requires patience and time. Explaining to the customer how to properly use the equipment is only one responsibility of the retail sales clerk. The clerk also must inform the customer of Medicare requirements. For example, if the patient is a Medicare Part B recipient, has a doctor ordered or prescribed the item in which he or she is interested? Does the item require a written order prior to delivery? If there is more than one item, are they contraindicated (e.g., a commode and a walker)? Are they two ambulation aids? If so, Medicare will pay only for the least expensive item.

Answers to these questions will vary based on the your decision to accept or not accept assignment. These are just a few of the myriad of complexities that often arise during the intake process, retail or otherwise.

Take another example, experienced by Velma Goertzen of Health-E-Quip in Hutchinson, Kan.: A Medicare patient entered the store with a doctor's order to buy a manual wheelchair. The customer insisted on paying cash and refused to deal with Medicare.

Additionally, the customer wanted to spend down assets to qualify for Medicaid. The salesperson explained that Medicare only pays for the rental of the manual wheelchair and that, because the customer was a Medicare recipient, Health-E-Quip was obligated to file the claim.