Question & answer
Switch to rehab pays off
DOVER, Del. — Twenty some-odd years after his parents made the switch from pharmacy to rehab and assistive technology, Adam Samuel's finally beginning to see the transition pay off. Avenue Medical, which Samuel now runs with his mother, was recently featured in a local Delaware newspaper as the best "up and coming" pharmaceutical and healthcare company. Other companies in the running? Try the pharmaceutical powerhouse AstraZeneca, which has an office in Wilmington, Del. Topping that, the company has doubled its annual sales to $1.5 million in the past two years.
HME NEWS: Why'd Avenue Medical get out of the pharmacy business?
ADAM SAMUEL: The big chains started coming in, and we didn't want to get squeezed out. Reimbursement became pathetic with pharmaceuticals, too.
HME: Is reimbursement any better for rehab and assistive technology?
SAMUEL: We do tons of Medicare/ Medicaid business — about 40% — and we get paid well. Reimbursement for rehab and assistive technology is very good when you know what you're doing. When you know how to file claims and get them approved, it's even lucrative. If you don't, though, yes, it's a nightmare.
HME: Did you always know what you were doing?
SAMUEL: No, in the past, I don't think we were doing it well, but we've made a lot of changes. There's really a trick to doing reimbursement, and I think we've mastered it. We take a lot of classes. We call funding sources. We ask them, "What are you looking for?" When we make a mistake, we ask, "Why didn't this go through?" Now, we don't make as many calls. We get the claim right the first time. We never tell people they need to pay for things out-of-pocket. People are always asking us, "How are you getting that paid for?" We've got physicians that trust us, and they know when they send their patients here, they're getting taken care of.
HME: Would you say your denial rate is under 10%?
SAMUEL: If that. If we get denied, we usually win on appeal. We get the physician to submit additional documentation. I think we lost only one appeal last year. And it was for something stupid like the dates of service didn't match up.
HME: Expansion plans?
SAMUEL: We're trying to keep it small. Once you start becoming big, you lose track of the customer, as well as what it takes to get them in equipment. We have one location with a staff of eight. I do up to eight evaluations a week, but I like to schedule five, so I can stay on top of paperwork. HME