HME NewsPoll: Providers use education to ward off denials

Thursday, May 12, 2011

YARMOUTH, Maine - The majority of HME providers are not only keeping track of their denial rates, they're working hard to reduce them.

According to a recent HME News Poll, 79% of providers are keeping track of their denial rates. They're trying to keep those rates in check by, among other things, educating everyone from their employees to referral sources to patients.

"We are asking our patients to play a part in the process by having them take notes to the MD that prompt them to document correctly," said Cliff Doss of Fort Smith, Ariz.-based AireCore Medical Services. 

Other strategies: Performing eligibility checks prior to delivering products and waiting to file claims until they're complete.

Despite their efforts, for 44% and 36% of providers, denial rates have stayed the same or increased in the past year. That's left some providers feeling discouraged.

"CMS has made it very difficult to comply with all of the documentation requirements," said David Warren, owner of Matthews, N.C.-based First Choice Medical. "No matter how hard you try, they can (and do) find something wrong with your claim."

High denial rates have led Affiliated Medical Equipment to stop providing CPAP machines to Medicare patients altogether, and Ed Wimbish, president of the Forestville, Md.-based company, said he is seriously considering dropping wound care, too. 

Among the 73 respondents who took the NewsPoll, oxygen was the top culprit for denials, followed closely by CPAP. Other top categories were diabetic supplies, hospital beds and ostomy supplies. 

Sixty percent of respondents had denial rates of 0% to 10%; 32% had rates of 11-20%; and 8% had rates of more than 20%.