Audits increase tension between providers, referral sources

Monday, April 12, 2010

YARMOUTH, Maine – The increase in Medicare audits has done more than wreak havoc on an HME provider's cash flow. It has created tension between him and his referral sources and doctors.

"There's no question--our relationships with our referral sources and doctors have suffered," said Carl Mulberry, president of Columbus Medical Equipment in Columbus, Ohio. "We have to go back and fight with them to get the proper documentation. I don't like fighting."

Providers have an alphabet soup of Medicare audits to deal with, including Recovery Audit Contractor (RAC) audits and Zoned Program Integrity Contractor (ZPIC) audits. That has raised the stakes--for them to collect appropriate documentation and for referral sources and doctors to deliver it.

As a result, providers find themselves having to play hardball with referral sources and doctors.

"I've had equipment denied because the order was not handwritten," Mulberry said. "So I go back to the doctor and say, 'I need it handwritten,' and he says, 'That's ridiculous; I use electronic signatures.' I say, 'Yes, it is ridiculous, but you have to change it.' It gets very heavy from time to time."

Making matters worse: Not all providers are playing hardball, tempting referral sources and doctors to take the path of least resistance.

"We've had three or four hospitals tell us, 'Well, not everyone is asking us for this information,'" said Rick King, CEO and president of ProMed DME in Los Alamitos, Calif. "What can you say? We continue to teach and train them and, hopefully, the auditors get to those other providers, too, so everyone's on the same page."

To help their cause, providers host in-services with referrals sources and doctors on a regular basis.

"We clinic with our doctors and therapists directly," said Greg Lord, director of Great Plains Rehab in Bismarck, N.D. "Any new information put out by CMS or our carrier--we share it with doctors and ask them to make adjustments accordingly. They're frustrated, too."

Mulberry has a better plan--increasing his cash business.

"I keep thinking things are going to turn around, but the only way I see to do that is to increase my cash business, which basically changes the focus of my business away from what I love," he said. "It's a sorry state of affairs."