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On the Road to Reimbursement
WHAT PROCESSES do you have in place to help steer you in the right direction along the reimbursement road? Last May, HomeCare magazine randomly surveyed 175 home medical equipment providers to see just how they handle the reimbursement process. Respondents even rated their respective durable medical equipment carriers on their performance. You can compare your answers to theirs in the following statistical report.
Which of the following products and services do you offer?
|
Beds & support surfaces |
73.7% |
|
Mobility products |
68.6% |
|
Respiratory products |
64.0% |
|
Disposables |
57.7% |
|
Rehabilitation products |
49.1% |
|
Respiratory therapy |
41.7% |
|
Prosthetics/Orthotics |
32.0% |
|
Rehabilitation services |
18.9% |
|
Infusion therapy |
16.6% |
|
Other |
23.4% |
|
Base: 175 |
Which one of the following best describes your business?
|
Home medical equipment provider |
48.3% |
|
Specialty HME provider |
9.2% |
|
HME with respiratory therapy |
24.7% |
|
HME with infusion therapy |
4.6% |
|
HME with pharmacy |
4.6% |
|
Other |
8.6% |
|
Base: 174 |
How many of your employees are involved in reimbursement-related tasks such as order intake, billing, accounts receivable and collections?
|
1 employee |
8.9% |
|
2 - 5 employees |
68.6% |
|
6 - 9 employees |
7.1% |
|
10 - 14 employees |
2.4% |
|
15 - 20 employees |
1.2% |
|
21 - 100 employees |
8.9% |
|
100+ employees |
3.0% |
|
Base: 169 |
|
|
Mean: 15.8 |
|
|
Median: 4.0 |
Do you assign individual employees to work on multiple kinds of reimbursement-related tasks?
Base 169
When doing order intake, what information do the employees gather during the initial call or visit?
|
Patient name, address, phone |
99.4% |
|
Physician name |
94.8% |
|
Patient insurance |
93.1% |
|
Patient has prescription |
90.2% |
|
Other contact person |
82.2% |
|
Patient already has like or similar equipment |
74.1% |
|
Patient interested in other products |
44.8% |
|
Other |
8.6% |
|
Base: 174 |
Do you give your in-house staff any formal training in reimbursement-related tasks?
Base 171
Do you assign individual employees to process reimbursement claims with different types of third-party payers?
Base: 157
Do you give your employees who do order intake any formal training in customer service?
Base: 175
Do you give the employees who do order intake any formal training in specific product knowledge?
Base: 172
Considering all of the claims you submit, what percentage are reviewed or denied?
|
None |
1.6% |
|
1% - 5% of claims |
30.9% |
|
6% - 10% of claims |
22.8% |
|
11% - 15% of claims |
5.7% |
|
16% - 20% of claims |
16.3% |
|
21% - 25% of claims |
6.5% |
|
26% - 30% of claims |
5.7% |
|
More than 30% |
10.6% |
|
Base: 123 |
|
Average |
16.5% |
|
Median |
10.0% |
|
Range - Low |
0% |
|
Range - High |
98.0% |
To which of the following payers do you submit reimbursement claims?
|
Private pay insurers |
96.2% |
|
Medicare |
94.9% |
|
Medicaid |
91.8% |
|
Managed Care (MCOs, HMOs, PPOs, etc.) |
79.7% |
|
Other |
22.2% |
|
Base: 158 |
Who on your staff handles third-party payer questions, problems or claim denials?
|
A billing employee |
53.5% |
|
A manager or supervisor |
43.3% |
|
An account receivable employee |
33.8% |
|
Whoever gets the call or letter |
10.2% |
|
An order intake employee |
7.6% |
|
Other |
7.0% |
|
Base: 157 |
How often are your reimbursement claims for the following products and services put into review or denied? (most often = 1, often = 2, sometimes = 3, rarely = 4)
|
Mean rating |
2.04 |
|
Most often |
10.7% |
|
Often |
7.1% |
|
Sometimes |
57.1% |
|
Rarely |
25.0% |
|
Base: 28 |
|
Mean rating |
2.03 |
|
Most often |
5.0% |
|
Often |
19.0% |
|
Sometimes |
50.0% |
|
Rarely |
26.0% |
|
Base: 100 |
|
Mean rating |
2.03 |
|
Most often |
5.0% |
|
Often |
22.5% |
|
Sometimes |
42.5% |
|
Rarely |
30.0% |
|
Base: 40 |
|
Mean rating |
1.92 |
|
Most often |
4.7% |
|
Often |
17.6% |
|
Sometimes |
42.4% |
|
Rarely |
35.3% |
|
Base: 85 |
|
Mean rating |
1.79 |
|
Most often |
1.7% |
|
Often |
15.5% |
|
Sometimes |
43.1% |
|
Rarely |
39.7% |
|
Base: 58 |
|
Mean rating |
2.10 |
|
Most often |
10.0% |
|
Often |
24.3% |
|
Sometimes |
31.4% |
|
Rarely |
34.3% |
|
Base: 70 |
|
Mean rating |
1.52 |
|
Most often |
0% |
|
Often |
9.3% |
|
Sometimes |
33.3% |
|
Rarely |
57.4% |
|
Base: 54 |
|
Mean rating |
1.53 |
|
Most often |
1.3% |
|
Often |
11.8% |
|
Sometimes |
25.0% |
|
Rarely |
61.8% |
|
Base: 76 |
|
Mean rating |
1.70 |
|
Most often |
1.0% |
|
Often |
11.1% |
|
Sometimes |
44.4% |
|
Rarely |
43.4% |
|
Base: 99 |
How often are your reimbursement claims to the following payers put into review or denied? (most often = 1, often = 2, sometimes = 3, rarely = 4)
|
Base: 136 |
|
|
Mean rating |
1.96 |
|
Most often |
5.9% |
|
Often |
10.3% |
|
Sometimes |
57.4% |
|
Rarely |
26.5% |
|
Mean rating |
1.96 |
|
Most often |
4.4% |
|
Often |
21.2% |
|
Sometimes |
39.8% |
|
Rarely |
34.5% |
|
Base: 113 |
|
Mean rating |
1.91 |
|
Most often |
8.3% |
|
Often |
7.5% |
|
Sometimes |
51.1% |
|
Rarely |
33.1% |
|
Base: 133 |
|
Mean rating |
1.73 |
|
Most often |
2.2% |
|
Often |
12.7% |
|
Sometimes |
41.0% |
|
Rarely |
44.0% |
|
Base: 134 |
What percentage of your denials do you appeal?
|
Average |
63.2% |
|
Median |
90.0% |
|
Range - Low |
0% |
|
Range - High |
100% |
|
Appeal all denials (100%) |
39.7% |
|
95% - 99% are appealed |
8.4% |
|
90% - 94% are appealed |
5.3% |
|
80% - 89% are appealed |
4.6% |
|
70% - 79% are appealed |
3.1% |
|
Less than 70% are appealed |
38.9% |
|
Base: 131 |
What percentage of your appeals are successful?
|
Average |
70.3% |
|
Median |
80.0% |
|
Range - Low |
0% |
|
Range - High |
100% |
|
All (100%) |
9.0% |
|
90% - 99% |
31.1% |
|
80% - 89% |
14.8% |
|
70% - 79% |
10.7% |
|
60% - 69% |
7.4% |
|
50% - 59% |
11.5% |
|
Less than 50% |
15.6% |
|
Base: 122 |
What are the top three reasons your reimbursement claims are reviewed or denied?
|
Payer question about medical necessity |
69.4% |
|
Missing information |
46.3% |
|
Inaccurate information |
35.1% |
|
Third-party payer error |
32.1% |
|
Product or service not covered by payer |
30.6% |
|
Payer question about claim code |
23.9% |
|
Other |
11.2% |
|
Base: 134 |
How would you grade the performance of the DMERC(s) you work with on the following? (1 = unacceptable, 2 = poor, 3 = acceptable, 4 = good, 5 = top marks)
|
Mean Ratings |
|
|
DMERC Region A |
2.96 |
|
Base: 24 |
|
|
DMERC Region B |
3.06 |
|
Base: 33 |
|
|
DMERC Region C |
3.58 |
|
Base: 57 |
|
|
DMERC Region D |
6.26 |
|
Base: 35 |
|
Mean Ratings |
|
|
DMERC Region A |
2.86 |
|
Base: 21 |
|
|
DMERC Region B |
3.06 |
|
Base: 34 |
|
|
DMERC Region C |
3.39 |
|
Base: 57 |
|
|
DMERC Region D |
3.06 |
|
Base: 35 |
|
Mean Ratings |
|
|
DMERC Region A |
4.06 |
|
Base: 17 |
|
|
DMERC Region B |
3.83 |
|
Base: 29 |
|
|
DMERC Region C |
4.15 |
|
Base: 52 |
|
|
DMERC Region D |
4.17 |
|
Base: 29 |
|
Mean Ratings |
|
|
DMERC Region A |
3.29 |
|
Base: 211 |
|
|
DMERC Region B |
3.42 |
|
Base: 33 |
|
|
DMERC Region C |
3.63 |
|
Base: 57 |
|
|
DMERC Region D |
3.44 |
|
Base: 34 |
|
Mean Ratings |
|
|
DMERC Region A |
3.23 |
|
Base: 22 |
|
|
DMERC Region B |
3.58 |
|
Base: 33 |
|
|
DMERC Region C |
3.77 |
|
Base: 57 |
|
|
DMERC Region D |
3.74 |
|
Base: 34 |
|
Mean Ratings |
|
|
DMERC Region A |
2.67 |
|
Base: 21 |
|
|
DMERC Region B |
2.53 |
|
Base: 32 |
|
|
DMERC Region C |
2.81 |
|
Base: 54 |
|
|
DMERC Region D |
2.67 |
|
Base: 33 |
|
Timely information |
3.99 |
|
Base: 149 |
|
|
Complete information |
3.16 |
|
Base: 147 |
|
|
Easy electronic billing |
4.07 |
|
Base: 110 |
|
|
Timely payment |
3.52 |
|
Base: 124 |
|
|
Accurate payment |
3.71 |
|
Base: 124 |
|
|
Timely reviews |
2.70 |
|
Base: 119 |
|
DMERC Region A |
3.14 |
|
Base: 126 |
|
|
DMERC Region B |
3.24 |
|
Base: 194 |
|
|
DMERC Region C |
3.55 |
|
Base: 334 |
|
|
DMERC Region D |
3.90 |
|
Base: 200 |
Which DMERCs process your Medicare reimbursement claims?
|
Average Number of Regions |
1.24 |
|
DMERC Region A |
17.1% |
|
DMERC Region B |
30.7% |
|
DMERC Region C |
45.7% |
|
DMERC Region D |
30.7% |
|
Base: 140 |
What percentage of your reimbursement revenue comes from each of the following payers?
|
Medicare |
47.6% |
|
Medicaid |
16.7% |
|
Private Pay Insurers |
13.6% |
|
Managed Care |
13.0% |
|
Other |
9.0% |
|
Base: 130 |
|
A majority of revenue |
44.6% |
|
Any revenue |
96.2% |
|
A majority of revenue |
3.8% |
|
Any revenue |
88.5% |
|
A majority of revenue |
1.5% |
|
Any revenue |
93.1% |
|
A majority of revenue |
5.4% |
|
Any revenue |
70.0% |
|
A majority of revenue |
6.9% |
|
Any revenue |
26.9% |
What is your total revenue?
|
Base: 131 |
|
|
Weighted Average (× $1,000) |
2,706.1 |
|
Less than $1 million |
44.3% |
|
$1.0 - $1.9 million |
24.4% |
|
$2.0 - $2.9 million |
11.5% |
|
$3.0 - $3.9 million |
3.8% |
|
$4.0 - $9.9 million |
6.1% |
|
$10 million or more |
9.9% |
What is your company's overall Days Sales Outstanding?
|
Base: 119 |
|
|
Average days |
72 |
|
Median |
65 |
|
Range - Low |
10 |
|
Range - High |
311 |
|
30 days or less |
15.1% |
|
31 - 60 days |
29.4% |
|
61 - 90 days |
38.7% |
|
91 - 120 days |
10.9% |
|
120 days or more |
5.9% |
If you calculate separate DSO averages by payer type, what is your average DSO with each of the following?
|
Medicaid |
65 days |
|
Managed Care (MCOs, HMOs, PPOs, etc.) |
56 days |
|
Medicare |
55 days |
|
Private pay insurers |
51 days |
|
Other |
60 days |
Do you calculate separate DSO averages by the type of third-party payer?
|
Base: 125 |
|
|
Yes |
19.2% |
|
No |
80.8% |
If you calculate separate DSO averages, what is your average DSO on each of the following?
|
Overall HME |
58 days |
|
Infusion therapy |
71 days |
|
Respiratory therapy |
49 days |
|
Respiratory products |
30 days |
|
Mobility products |
73 days |
|
Rehabilitation services/products |
90 days |
|
Prosthetics/Orthotics |
30 days |
|
Disposables |
32 days |
|
Beds & support surfaces |
28 days |
What percent of your revenue is generated by the following products or services?
|
Respiratory products |
21.8% |
|
Mobility products |
18.8% |
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© 2009 Penton Media Inc.
