PROVIDERS VIEW MEDICARE AS FICKLE, MANAGED CARE AS SLOW TALK ABOUT A HOT BUTTON! When we asked home medical equipment providers in our recent 2000 HME Reimbursement Survey to tell us what the industry's biggest reimbursement problems are and how they should be remedied, it sparked fiery responses. We share some of them with you here.

What do you think is the industry's biggest reimbursement problem or challenge? "Government ineptitude and the attitude that everyone is a crook. Managed care pricing quality out of service and the inability to accept new products at higher rates."

"Medicare has a complicated billing system. There is no case management opportunity to discuss individual case situations. It will pay for infusion therapy for the duration of hospitalization but will not cover home care."

"Problems: 1) Insurance companies and Medicare changing coverage guidelines and policies; 2) customers not understanding their coverage, deductibles and co-payments; 3) private pay of co-payments, deductibles and noncovered items; 4) downward pressure on pricing without regard for service or labor intensity surrounding product."

"Durable medical equipment regional carriers are using loopholes in regulations to deny claims or ask for physician records in hopes of denying items that used to be paid for easily. Stalling on payment by asking for unnecessary information. A certificate of medical necessity itself does not meet all their requirements on many things."

"Complete, up-to-date information in an easy-to-read format. Have to look in too many places for coverage billing information."

"Getting the [certificates of medical necessity] back from the doctors is the number one problem in billing for reimbursement. Doctors do not have the time to stop and consider the answers needed to get items covered. Many just sign, date and return, and then they must be sent out again."

"Decreasing reimbursement, but more paperwork, insurance, licenses and soon-to-be surety bonds, not to mention the costs of billing, inventory, delivery and pickup."

"Managed care understanding timely payment and educating customers in what it pays and doesn't pay."

"Simplify the process of proving medical necessity. Have some way of reporting insurance companies that continually deny claims for lack of information when all the information has been submitted. Educate doctors on the correct way to fill out a form."

"Lobby. Inform the lawmakers that when patients can't afford to keep their glucose levels under control, the results are well-known. Hospitalization costs, amputations, kidney failure and dialysis are certainly not saving the government dollars."

"Shake the idiots at the Health Care Financing Administration. Let them know you can't make suppliers responsible for interrogating beneficiaries regarding their entire past usage of Medicare items! Nor can they expect suppliers to get stung paying for the beneficiary's products, as regularly happens. How about a reasonable cost-of-living adjustment? How can an industry hamstrung by mediocre reimbursement be expected to absorb inflation, increased insurance costs, payroll expenses, gasoline prices heading into the sky and still provide quality to the `sacred cow,' the Medicare beneficiary? We can't!"

"Actively work with our legislators. Give them a good view of what we do and show them we are more than equipment techs. Prove to them the real cost of supplying equipment - billing costs, etc. Accountability and responsibility are not equal - too much is out of control."

"It will take a long time to turn this around. There is no cure-all antidote. Just a lot of plugging away at the system."