The squeamishness that many HMEs experience when tackling the ticklish job of collecting Medicare's 20% co-payment has paid off big-time for Bargmann Management and HCS. In late June, the Greater Akron (Ohio) Chamber of Commerce named Bargmann its 2007 New and Emerging Business of the Year.

The company formed in 2003 and generates 85% of its business helping providers collect beneficiary co-pays. At the end of 2006, the company employed 20 associates. It now employs 65 and expects to double that by early 2007. "There is just such a need for it," said Lisa Bargmann, president and CEO. "Providers are afraid to approach the subject. It was somewhat taboo because they've always felt they would come across as insensitive if they broached the financial responsibility aspect up front." But with Medicare squeezing reimbursement across almost all product categories, providers can no longer afford to let beneficiaries slide on the co-pay, or worry that referral sources might get mad at them for trying to collect, Bargmann said. Bargmann, a former HME herself, helps providers manage their receivables in two ways. She'll teach them how to collect co-pays themselves, or, as many prefer, her company will do it for them.

"It's an awkward situation," said Sara Bauer, director of education for The VGM Group, which has contracted with Bargmann Management." A lot of people don't know how to ask (for the co-pay). That's why we partnered with them, and they've come up with a program to educate our providers on what to do and how to be more attentive to collecting the co-pay."

Indeed, when collecting co-pays, providers don't endear themselves to referral sources or beneficiaries if they take a heavy-handed approach. With that in mind, Bargmann tries to "kill them with kindness." Her associates call all first-time patients within 30 days of when an invoice is due and explain the co-pay and answer questions. Many patients, for example, don't understand the difference between the co-pay and annual deductible; they think Medicare covers DME 100%, Bargmann said.

For rental equipment, the company will not call a patient again unless he has a history of not paying the co-pay. If a patient needs to work out a payment plan, they'll do that, too.

Recently, HMEs who provide CPAP and other sleep-related services have started approaching Bargmann for help collecting co-pays from this working-age group. This "strange dynamic" appears to bode well for her company's future growth.

"It's not what I would have expected," Bargmann said. "Maybe they are just used to paying the co-pay at the doctor's window, but now that they are getting into diagnostics and DME they are not familiar with how the process works."