Consultant's corner: Troubling and motivating providers

Tuesday, January 8, 2013

When it comes to the HME industry, instead of in with the new and out with the old, it’s in with the new and more of the old.

For 2013, the new includes a provision in the recently passed "fiscal cliff" deal that extends the look-back period for audits from three years to five years. The old includes a continuing stream of reviews by CMS contractors that result in staggeringly high error rates.

But the new also includes this: Providers approaching 2013 with a renewed focus on succeeding by becoming more sophisticated businesses.

Here’s what three industry consultants had to say about what’s both troubling and motivating providers in early 2013.

More money, more problems

Even though providers must keep documentation, in some form, on hand for seven years, extending the look-back period from three years to five years still spells big trouble, especially for products like power wheelchairs, says Bruce Brothis.

“If you’re talking about a power wheelchair that was paid for four years and 11 months ago—when you look back that far, the rules were markedly different back then,” said Brothis, president of Allegient Billing & Consulting.

While providers aren’t happy about the change, CMS contractors are, Brothis said.

“They have two more years of places to go to make money,” he said.

Mistakes to go around

It used to be that CMS contractors reviewed the error rates only for bread-and-butter HME like oxygen concentrators. Not anymore, says Roberta Domos.

“Now it’s everything from beds to wheelchairs to back braces to TENS units,” said Domos, owner of Domos HME Consulting Group.

To help reduce error rates, which can be as high as 98% for products like enteral supplies, Domos provides clients with “cheat sheets” to give to referral sources to help them complete their chart notes.

“They can keep their notes short and sweet,” she said. “They don’t have to write a book, except for wheelchairs.”

Men and women of action

When it comes to changing their businesses, providers are first changing their mindsets from, “I can’t do that,” to “I think I’m going to do that,” says Sarah Hanna.

“They know they can’t be unsophisticated business people anymore,” said Hanna, vice president of ECS Billing & Consulting. “They know they have to dig in and think about what needs to be done and in what manner. It’s really refreshing.”

In addition to mixing up their product offerings, providers are putting operations under the microscope to improve everything from collections to denials to turnaround times, Hanna says.

“They’re really focusing on what metrics to look at and how to read reports,” she said. “It’s a whole new marketplace. You can’t just take care of people in your neighborhood anymore. You have to have a corporate mindset.”