Tired of the 'ping pong effect'?

Tuesday, December 4, 2012

GAINESVILLE, Fla. – A new company that helps physicians complete the required documentation for power mobility devices (PMDs) says it has a 100% approval rate on prior authorization requests.

Since launching in September, DMEevalumate.com has moved 247 approvals for PMDs through Medicare, Medicaid and private insurers, according to co-founder Jamie Loper.

“We’ll refund providers if they submit paperwork that physicians created using our program and it gets denied for medical necessity,” she said. “We haven’t had to issue a single refund.”

DMEevalumate.com is an online program that providers register and pay for, and invite physicians to use. It walks physicians through the process of prescribing a PMD, uses algorithms to compare the information they submit with Medicare’s coverage criteria and determines whether a patient qualifies. If the program confirms medical necessity, it will generate an appropriate seven-element prescription and a face-to-face evaluation that physicians can then send to providers.

DMEevalumate came about when a group of physicians approached Loper, a billing consultant at the time, to create a program to “bridge the gap” between them and providers, a problem that took on a new sense of urgency in September, when Medicare started requiring prior authorizations for PMDs in seven states.

“They were tired of this ping pong effect—the paperwork going back and forth between their office and the DME,” she said. “They were being told their patients, who they knew qualified, didn’t qualify because they didn’t cross a T or dot an I. It was frustrating.”

The average price for using the program is $20 to $30 per evaluation, depending on volume—a small price for providers to pay, Loper says, for peace of mind.

“Their role becomes much easier,” she said. “When they get paperwork from the physician, they know it meets the criteria. They can dispense the equipment and know they’re going to be able to keep what they get paid.”

While the program applies only to PMDs right now, DMEevalumate.com is in the process of developing a module for respiratory products, says Katherine Sims, director of marketing and communications.

“We plan to grow and evolve,” she said.


I think these agencies such as DMEevalumate.com are doing a wonderful service.  However at the same time, it is a shame a DME provider has to resort to pay an outside source to do what their own staff cannot accomplish-- not because of lack of skill or incompetence, but because the relationship between physician & DME provider is badly damaged.  Ordering physicians are tired of this ping-pong effect because those that are requesting the documents are having a difficult time relaying what is needed in a simplified manner.