When bennys can change their mind

Thursday, February 28, 2002

Recently, an article entitled "Medicare Capped Rental" authored by Nancy Burma appeared in your Dec. 2001 HME News publication. In the article, Ms. Burma discusses an issue related to claims processing for items in the capped rental payment category and the policies in each of the four durable medical equipment regional carriers (DMERCs). CIGNA Medicare, the carrier for DMERC Region D, was cited as having the same claim processing policy as DMERC Region B (AdminaStar Federal). This information is incorrect.

The specific issue addressed in her article is whether the beneficiary can change their mind on their option to purchase or continue to rent a capped rental item. The regulations governing payment for capped rental items are provided by the Centers for Medicare & Medicaid Service (CMS). These regulations are published in the Medicare Carriers Manual (MCM), 5102, and republished to suppliers in the Region D DMERC Supplier Manual.

There is no provision for the beneficiary to make the rent-purchase option other than "one month from the date the supplier makes the offer." CIGNA Medicare will make an individual consideration decision based on the specific details of the situation under two circumstances: 1) CIGNA Medicare receives evidence that there was a claim processing error in the beneficiary's original rent/purchase option, or 2) there is evidence presented by the beneficiary that the supplier failed to provide the rent/purchase option in the time frames specified in the regulations above.

I trust you will communicate this information to the author of the article and publish a correction at your earliest convenience.

- Robert D. Hoover, Jr., MD, is medical director of CIGNA Medicare

Nancy Burma responds:
Prior to publishing this information [in last month's Smart Talk column on reimbursement], we contacted all the Customer Service Units at all four Regional DMERCs to "confirm" the information we had. We then proceeded to publish the (mis)information we were given. (For more on this issue, see Burma's article about customer service units.)

Reality check
To start, I think HME News is head and shoulders above all the other trade publications.... That being said, I disagree with your closing editorial comment in the 1-15-02 issue. I would propose Invacare's sales decline has less to do with the recession, and more to do with the decline in service behind the scenes to their dealers. I believe this to be a direct reflection of their 'stockholders first' attitude. While I severely doubt they will follow the trail of Graham-Field, I am guessing their reality check will continue for awhile.

- Jeff Sobey, Care Medical Equipment in Portland, Oregon

Missed the point
I just read your article ("Apria's supplies biz raises concerns," Feb. 15, 2002). You missed the point and should have expanded the article to include why Apria and others are separating out the supplies. Medicare's allowables for supplies is at or below cost!! That's why. The unnamed official at the DMERC should have been asked what is being done to address the underlying problem leading to decisions like this.

Don't get me wrong, I'm not an Apria fan but rather quite the opposite. I own an several independent DME, pharmacies, and home IV companies that compete against Apria however I struggle daily whether to drop the supply line entirely. We do not accept assignment on most of these items. If I dropped the line, as some national HME providers have done, I would reduce access to care. If I take assignment on the items, I'll be forced to close my doors because I can't meet overhead requirements on low or non-existent margins. The end result is reduced access to care. What Apria is doing and what I'm doing as non-assignment, allows patients to obtain needed supplies and still keep my lights on.

Please make an effort to correct this article. It seemed that HME News was taking the DMERC's side of the issue, almost a right/wrong article.

- Keith Ayers vice president/owner of Apple Discount Drugs
Medline's new service
In reference to the article that HME News ran in its Jan. 15 2002 issue entitled "Medline, PFS partner to create Web-based billing resource," I wanted to clarify some inaccuracies in the story.

1) HMG is a reimbursement resource, providing information such as E-CMNs, insurance verification and on-line training. HMG is not a "billing service" as was stated in the article.

2) The article quotes an unidentified "billing expert" who commented on the site but to our knowledge has never visited askhmg.com since it is password protected. His/her comments should be taken with a grain of salt since ask.hmg was developed specifically for the average HME dealer and may actually be viewed as competition in the eyes of "experts" who bill for their time to consult on reimbursement and billing issues.

3) The DMERC information provided on our site is not "regurgitated" as this expert said. We quote directly from the DMERC's with no deviation or inaccuracies.

4) The expert says that "people" should know "these things." Maybe billing experts should know these things but for the typical HME dealer, Medicare reimbursement is the most misunderstood and confusing part of their job. To realize the full reimbursement, dealers need to keep abreast of Medicare and commercial intake requirements, coding, CMN and insurance verification management, Medicare Denial Management, and on and on. This is an overwhelming amount of information to learn and understand. That is why they need resources like HMG to help them with this process. It should be noted that we have incredible reviews from our HME clients and colleagues nationwide.

I feel these are important distinctions to make to more accurately represent the benefits HMG provides to the dealer industry.

- Melissa R. Harris is vice president of Physician Filing Service
Sideliners have no right to complain
I received several calls commenting on my article about the merger of AHCA with AAHomecare. What surprised me was that not everyone recognized the value of this merger for them as DME/HME dealers.

By combining the strength of two allied professions, we now have the ability to go to Congress and speak on your behalf with a great deal of clout and strength. Together, the new AAHomecare, not only represents DME interests, but also those of home health agencies which represent all of the beneficiaries. Yes, their voice as well!

However, my concern is that some of the dealers who scoffed at this merger are NOT members of AAHomecare. I must discount what they said because by not supporting the major industry organization, they do not have the privilege to complain. Join AAHomecare and make your voice heard if you feel strongly about an issue. But if you do not belong, do not complain.

- Shelly Prial