Regarding 'OIG gives advice on loan closets' in the June issue, the OIG's attitude on this issue will do more harm for the DME industry than it will meet the needs of the patient. If DME #1 has a loan closet in a doctor's office and DME #2 does not, which provider do you think the doctor will choose?
In a perfect world, the patient would have the freedom to choose, but if the patient chooses DME #2 and the equipment is not stored in a closet from this DME provider, what is the doctor to do? Should he, in the best interest of the patient, loan the patient equipment from the closet which belongs to DME #1, or call DME #2 and let the patient wait on the equipment to be delivered?
This scenario exists day to day in this industry. It is a very competitive field, and if this is to be considered "normal practice", then doctors will be faced with the decision of which DME provider will store equipment and which will not. This in my opinion, will cause many DME providers to bid, overtly or covertly, for the space in the loan closet. Providers who will not pay for the space, will not receive any patients from the doctors.
There are doctors' offices in every city who will only refer patients to DME companies that will supply them the personnel or equipment to actually perform the test that will qualify the patient for oxygen. So why should the use of a loan closet be any less a reason to sway a doctor to use a particular DME closet?
- Tom Antone is a former president of NAMES and an attorney who recently retired from Mintz, Levin et al in Washington.
Same or Similar
I am writing in reference to your article in the Aug. 15, 2002 edition, entitled "Same or Similar Denials Burn Region D Providers." In your article you quote several sources that assert that denials for same or similar equipment appear to be skyrocketing in Region D.
Provisions in the Privacy Act prohibit Region D DMERC customer service representatives from releasing confidential information, including claim history, without the consent of the beneficiary. Providers have the option of arranging a 3-way call between the provider, beneficiary and the DMERC; however, as stated in the article, the key to preventing or limiting these denials begins with the intake process.
CIGNA Medicare has worked closely with the Region D DMERC Advisory Committee and CMS to develop an intake form This suggested form can be used to help ensure that complete and accurate information is obtained at the time of intake. It is intended only as a tool to assist providers in obtaining information. This form is not required for claim submission and does not replace obtaining an Advance Beneficiary Notice (ABN) when there is reason to believe the item(s) may be denied as not medically necessary. The intake form, along with policy updates, informative articles and frequently asked questions can be found on the CIGNA Medicare web site at www.cignamedicare.com/dmerc.
- Robert Hoover, M.D. is medical director for the Region D DMERC.
Two licenses necessary
HMENews asked if DME providers require higher standards and I answer, unequivocally "YES."
To bring DME up to the level of recognition which other healthcare professionals have earned, not one, but two licenses should be issued by each state. The first should be to the company. In order to qualify, it must show that it is in compliance with all state, federal, OSHA and ADA requirements. The second is to the principal. If he or she is a pharmacist, or a nurse, that license could be adequate. Still, all dealers must show that they have the necessary knowledge to be awarded a license. The license exam to be prepared by the State Board of Regents, Board or Pharmacy, or equivalent. This should be completed be with the assistance of the state DME association and AAHomecare. The location should also be subject to random review by appointed inspectors to be sure that it has remained in compliance with all regs.
- Â Sheldon Prial