“Diet.” “Reimbursement.”
The mere mention of either word brings up feelings of dread and frustration, mixed with the promise of great rewards.
Don't ask what made me think about dieting as our staff was putting together the magazine's annual Reimbursement Survey. I'm on a diet at the moment (I've tried them all, from grapefruit to South Beach), and who knows what crazy connections go on in a French fry-deprived head?
Maybe the belt-tightening most providers are considering these days made me remember that notching in my own belt is a great incentive for sticking to my current calorie-counting regime. (Well, that and the fact that bathing suit season is fast approaching.)
Idle musings aside, I can attest that dieting is no fun. Neither is dealing with reimbursement, at least according to the providers who participated in our survey this year. The results show that working through the complex and exacting requirements of reimbursement, from Medicare or any other payer, continues to be a challenge for home medical equipment companies. And with the ever-strict compliance climate, most experts say it's not going to get any easier.
But our findings also show that with targeted employee training and tightened control of billing procedures, some problems can be mastered. In only one example, simply sharpening up the patient intake process — making sure medical necessity documentation is in order — can cut down on the most common reason for claim denials.
Looking beyond reimbursement practices, HomeCare's survey also shows the larger issue of mandated reimbursement cuts — which will hit wheelchairs, nebulizers, diabetic supplies, air mattresses and oxygen in 2005 — is a major concern for most home care providers. Who wouldn't be nervous about government-controlled pricing that threatens to squeeze the reimbursement lifeblood out of portions of this business?
Although looking at the numbers in our survey won't stop the cuts from coming, examining the results can help you get ready for them. Measuring your company's reimbursement performance against that of other providers can point to areas that may need improvement and help you strengthen protocols.
The tides of reimbursement may ebb and flow, but one constant is a cinch: now more than ever, you need to keep claims clean to keep those payments coming.
As for my diet? My will power seems to ebb and flow as well, but I'm hopeful the next time we meet, you'll see a slimmer, trimmer me.
See “Washington Wit & Wisdom” on page 60 for information on how you can help the industry fight the FEHBP-based reimbursement cuts mandated by the Medicare Modernization Act. Your involvement matters.
