Event spotlight: Structure and response

Tuesday, February 26, 2013

One of the basic concepts of getting reimbursed is that it’s not a single act, but a series of processes that proceed in a logical order, says consultant David Franklin. 

“If you screw up any one step along the way, you negate the final outcome,” said Franklin, president of Advanced Care Consulting Services.

To that end, Franklin has put together a nuts-and-bolts look at the reimbursement process for the National Home Infusion Association’s (NHIA) Reimbursement Pre-Conference on April 8. The NHIA brought the pre-conference back after a five-year absence in response to provider demand. 

Challenges for home infusion providers include physician documentation and a lack of standardization among payers, said Franklin.

“Every payer has different requirements,” he said. “Medicare requirements tend to be the most stringent. Usually, if you’re in compliance with those, you’ll be in compliance with everyone else.”

As with providers across other sectors of the home medical equipment industry, home infusion providers must contend with an increased number of audits, says Franklin. They must learn to be proactive when it comes to the audits and appeals process, he said.

“They don’t set up a structure to deal with it, they just respond to what comes in,” said Franklin. “They miss out on tons of money because they are missing administrative protocols. For example, they might only have so many days to respond to a request. They lose simply by lack of response.”