Two new products promise to help providers check a patient's Medicare eligibility with ease

Sunday, April 30, 2006

WEST SPRINGFIELD, Mass. - Until this year, checking a patient's Medicare eligibility more than occasionally proved so cumbersome, time-consuming and costly that, like most providers, All-State Medical often said forget it.
"It wasn't worth it," said Marcus Suess, president of the Tampa, Fla., HME. "The risks of being denied were acceptable to us for the time spent on the phone."
All that changed when Suess began using Diabco's real-time Medicare eligibility software, Me-First. Diabco unveiled its product at Medtrade Spring in March. Noble House introduced a similar Medicare eligibility program in January.
Both vendors call their products a quantum leap over Medicare's clunky Passport system, which chugs along at a snail's pace. In fact, so slow is Passport that many providers, like Suess, shun it and take their chances that patients are eligible and claims will be paid.
In the current climate of increasing competition and decreasing reimbursement, providers can no longer afford to do that, said Diabco President Edward Kutt.
"The industry has a 25% denial rate because (providers) aren't able to check eligibility," Kutt said. "They should be doing that every time they bill and they are not. If you get a denial and you have to rebill it or you don't get paid, your profits are going out the window."
Now, with the click of a button an HME can check on a patient's Medicare eligibility and receive the information in a matter of seconds, say execs at Diabco and Noble House.
Providers no longer have to bill not knowing if a patient has or has not met his annual deductible. The programs, which access Medicare's patient database (the common working file), also say whether a patient belongs to an HMO or has a secondary insurer. If the patient has spent time in a hospital or nursing home, the programs report that, too.
The programs allow providers to check one claim at a time or hundreds and are compatible with other HME billing software.
"What a lot of providers do is let every claim fly through and whatever sticks sticks," said Lisa Stone, vice president of marketing and sales for Noble House. "That adds up and can cost the provider a lot of money."
Jim Clark, president of Clark Medical and Respiratory Supply, knows that firsthand. Over the past few months, he's had to repay Medicare thousands of dollars because he billed for patients he didn't know had spent time in nursing homes.
What's more, with Medicare Part D transitioning patients to HMOs, the risk of billing for an ineligible patient is greater than ever, say Clark and other providers.
That makes the new products by Diabco and Noble House that much more appealing, they say.
"That is what I want," said Clark. "I'm losing thousands of dollars every month, and if we can buy a machine to do what a person does, we must buy the machine."