ANSWERS TO YOUR INDUSTRY QUESTIONS What are the most important factors to highlight about your company when answering a managed care equest for Proposal?

THE MOST IMPORTANT factors differ by the type of managed care organization sending out the RFP. My clients have had great success in sending a series of e-mails or faxed questions to the manager at the managed care organization who is responsible for answering the RFP. The e-mail correspondence serves two purposes. First, you can find out the areas to highlight; second, it helps you develop a relationship with the organization sending out the RFP if you don't already have one. It certainly makes the company aware that you are very interested in its business.

In general, RFPs need to be well-written, grammatically correct and well-organized. The reviewing managers are usually most impressed by quality management systems, JCAHO accreditation, geographic service coverage that matches up with the employee base, a history of taking care of managed care patients, fast response times, service guarantees and special programs (such as disease management) that improve care and reduce costs. Another topic of keen interest is the flexibility of the HME company in conforming to the cost-containment, billing and medical review processes of the MCO.

-Answered by Alison Cherney, president of Cherney & Associates, 9719 Concord Pass, Brentwood, TN 37027; 615/ 776-3399; fax 615/ 776-3490; e-mail: cherneyaj@aol.com; Web site: www.cherneyandassociates.com

Do we need to verify a patient's insurance before services are rendered as long as we eventually check his or her coverage?

REVENUE QUALIFICATION is a critical component of the successful home medical equipment provider's front-end process. Whenever possible, this procedure should be completed before delivery of equipment or services to ensure that the company is not exposed to potential bad-debt loss. A comprehensive insurance verification form should be completed for each payer to which the company intends to submit a claim for payment. Followed consistently, such a practice can help ensure that the company's bad-debt exposure is limited due to denials that the patient was ineligible at the time of service or that the services were not covered by the patient's/subscriber's policy.

-Answered by Lisa Shelly, accounts receivable manager, HealthCor Holdings , 2480 W. Fourth Ave., Suite 24, Denver, CO 80223; 303/936-0330, ext. 294; fax: 303/936-1180; e-mail: lisa.shelly@hcor.com

If a patient owns both stationary and portable oxygen systems, will oxygen refills (for portable) be covered and separately paid?

ACCORDING TO THE Region B DMERC Payment Policy, a portable contents fee can be paid separately only when the beneficiary owns a concentrator and rents or owns a portable system; or when the beneficiary rents or owns a portable system and no stationary equipment exists.

-Answered by Region B DMERC, AdminaStar Federal, P.O. Box 7078, Indianapolis, IN 46207-7078; 317/577-5722