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DME Billing Software – WWS https://wws.wonderws.com Empowering HME Providers Nationwide Wed, 10 Aug 2022 16:21:16 +0000 en-US hourly 1 https://wordpress.org/?v=6.9.4 How does the top DME companies make the right decisions on product selection and inventory levels in a landscape that is changing every day https://wws.wonderws.com/2022/06/02/how-does-the-top-dme-companies-make-the-right-decisions-on-product-selection-and-inventory-levels-in-a-landscape-that-is-changing-every-day/ https://wws.wonderws.com/2022/06/02/how-does-the-top-dme-companies-make-the-right-decisions-on-product-selection-and-inventory-levels-in-a-landscape-that-is-changing-every-day/#respond Thu, 02 Jun 2022 01:51:18 +0000 http://www.wonderws.com/?p=11217 To help you make better decisions for your business, we conducted a survey with 153 medical directors and other medical staff at top DME companies nationwide. We asked these medical professionals to share their insights on current challenges pertaining to the management of their inventory portfolio.

DME Companies

Key Findings: 50.0% of the medical directors and staff are currently purchasing between 2.0 and 5.0 products, while 49.0% are purchasing between 5.0 and 10.

It’s simple. They rely on the best available data. Data is the key to overcoming many of the issues facing the DME industry.

DME needs to be treated in the same way as other pharmaceutical products. Prescription records of prescribers should be kept electronically and linked to the patient to be used by the supplier.

To be able to manage inventory effectively, it’s important to understand the unique characteristics of both specialty and traditional medications — for example, how quickly they turn over in the supply chain and how many days are needed to reach the end user.

“These complexities are not new, but we have to understand how to manage them better as we have a more technologically advanced delivery system,” said Gopal Takru, president of Medco Health Solutions.

To create a solution for our DME providers, WWS provides a proprietary data analytical model to help DME providers in making the right decisions on product selections and inventory levels in a landscape that is changing every day.

However, you don’t need to be a programmer to reap the benefits of data analytics. In fact, with the right tools and resources, anyone can become a data-driven marketer. And that’s exactly what WWS accoamlisehes with the data analytical model. 

Whether you’re a seasoned marketing professional or a DME newbie, its important to obtain valuable insights to increase your revenue and better engage with your customers.

DME companies are realizing the value of analytics and are using data to drive decision-making for improving outcomes and lowering costs. More than half of providers are using analytics to increase efficiency, according to a recent survey from the DME Association of Florida.In addition, 84 percent of providers reported that they use analytics to reduce costs and improve outcomes.

In the past, charts, graphs and spreadsheets were the primary tools to view data, but with the increased demand for better data analysis, a more modern and innovative approach is needed. The need for data visualization is also present in many other industries, particularly in ones that require customization of a product or services to a specific customer. In the DME industry, being able to quickly and easily provide a customer with a visual representation of their data has maximized customer satisfaction and potentially boosted profits.

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DMEPOS Medicare Competitive Bidding Temporary Gap Period Lapses https://wws.wonderws.com/2018/11/21/dme-medicare-competitive-bidding-temporary-gap-period/ https://wws.wonderws.com/2018/11/21/dme-medicare-competitive-bidding-temporary-gap-period/#respond Wed, 21 Nov 2018 12:30:06 +0000 http://www.wonderws.com/?p=8110 Durable Medical Equipment, Prosthetics,Orthotics, and Supplies Medicare Competitive Bidding Program: Temporary Gap Period

Unless you’re a healthcare worker using durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) or are a home healthcare company, you probably have no idea what Medicare’s DMEPOS Competitive Bidding Program (CBP) is or how it affects healthcare equipment suppliers and patients.

Frankly, it’s been a thorn in the sides of many DMEPOS companies for years. Imagine their glee when the Centers for Medicare & Medicaid Services (CMS) proposed changes to the program.

All Medicare Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Competitive Bidding Program contracts expired on December 31, 2018. As of January 1, 2019, there is a temporary gap in the entire DMEPOS Competitive Bidding Program that CMS expects will last until December 31, 2020

During the temporary gap, any Medicare enrolled DMEPOS supplier may furnish DMEPOS items and services to people with Medicare. In most cases, people with Medicare won’t need to switch suppliers on or after January 1, 2019. 

  • Medicare beneficiaries may receive DMEPOS items from any Medicare-enrolled supplier until such time as new CBP contracts go into effect.
  • When competitive bidding resumes, it will be under new program rules, as discussed below.
Future Competitive Bidding Program Rules

In a final rule scheduled to be published on November 14, 2018, CMS adopted a number of “market-oriented reforms” and technical policy changes for future rounds of competitive bidding. According to CMS, the new rules will simplify the bidding process, preserve beneficiary access to items and services, and make the DMEPOS CBP more sustainable.

Of particular note, CMS has finalized its proposed “lead item pricing” methodology. Rather than bid on each item/HCPCS code in a product category for each competitive bidding area (CBA), suppliers will submit a single bid for the item in the product category designated by CMS to have the highest total nationwide Medicare allowed charges.

Proposed Changes Are a Win/Win

According to a CMS Newsroom Fact Sheet, “Beginning on January 1, 2019, beneficiaries may receive DMEPOS items from any willing supplier (until new contracts are awarded under the DMEPOS CBP).”

Home healthcare supply companies are breathing a big sigh of relief about the proposed changes.

The proposed changes will benefit to small DME companies by allowing them to market their products and company to providers, facilities, and nursing agencies without limiting their customer base to non-Medicare insurances.

Even though Medicare fee schedule is low, it opens up the market to more customers and creates a fairer playing field for all companies, which will result in better service to beneficiaries.

For those companies who didn’t have contracts due to CBP, but now do, the only downside is they’ll need to jump back through the hoops of government regulations to get their Medicare claims paid.

To learn more about Medicare’s Temporary Gap Period or the future of Medicare Competitive Bidding, follow the link http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSCompetitiveBid/index.html?redirect=/DMEPOSCompetitiveBid/

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How CMS Payment Rules Have Changed For DMEPOS From July 2014 Till Date https://wws.wonderws.com/2018/11/12/cms-releases-dmepos-rule/ https://wws.wonderws.com/2018/11/12/cms-releases-dmepos-rule/#respond Mon, 12 Nov 2018 13:30:55 +0000 http://www.wonderws.com/?p=8085 CMS proposed a number of payment policies to durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) from July 2014 till date. Here’s the historical payment rules of each year.

CMS Proposed Polices and Payments rates for End-Stage Renal Disease providers for CY 2015

On July 2, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2015.

  • This proposal would introduce new quality and performance measures to improve the quality of care by outpatient dialysis facilities treating patients with end-stage renal disease and proposes to implement the Affordable Care Act mandate to bring more competitive bidding for durable medical equipment.
  • The rule also proposes changes to the ESRD Quality Incentive Program (QIP), including for payment year (PY) 2017 and PY 2018, under which payment incentives are applied to dialysis facilities to improve the quality of dialysis care.
  • This rule also addresses issues related to the coverage and payment of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

A separate fact sheet addressing the payment provisions of the ESRD PPS for CY 2015 can be found here: http://www.cms.gov/Newsroom/Newsroom-Center.html.

CMS Updates to Policies and Payment Rates for End-Stage Renal Disease Facilities for CY 2016 and Changes to the ESRD Quality Incentive Program

On October 29, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2016.

  • The ESRD final rule is one of several rules for calendar year 2016 that reflect a broader Administration-wide strategy to provide quality care at lower cost by improving ways to deliver care, pay providers, and use information.
  • Provisions in these rules are helping to move our health care system to one that values quality over quantity and focuses on reforms such as measuring for better health outcomes, focusing on disease prevention, helping patients live successfully at home, helping manage and improve chronic diseases, and fostering a more efficient and coordinated health care system.

To read the complete update click the link https://www.cms.gov/newsroom/fact-sheets/cms-updates-policies-and-payment-rates-end-stage-renal-disease-facilities-cy-2016-and-changes-esrd

CMS releases final rule for 2017 ESRD payment bundle

The Centers for Medicare & Medicaid Services issued a final rule on Oct. 28, 2016 that updates payment policies and rates for the End-Stage Renal Disease Prospective Payment System for 2017. The final rule also made changes to the ESRD Quality Incentive Program (QIP), including payment years 2019 and 2020.

Changes to the ESRD PPS for 2017
  • The finalized CY 2017 ESRD PPS base rate will increase $1.16 to $231.55, compared to the 2016 rate of $230.39.
  • The 2017 home and self-dialysis training add-on payment adjustment will be $95.60, an increase of $45.44, compared to the 2016 add-on of $50.16.
  • CMS will provide coverage and payment for renal dialysis services in 2017 by an ESRD facility to an individual with acute kidney injury. Under the law, the payment will be the amount of the ESRD PPS base rate, as adjusted by the wage index.
CMS Updates to Policies and Payment Rates for ESRD Prospective Payment System, Quality Incentive Program, and Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury for 2017

On October 27, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2018.

  • The ESRD PPS rule is one of several rules for calendar year (CY) 2018 that reflect a broader Administration-wide strategy to support the patient-doctor relationship in health care and promote flexibility and innovation in the delivery of care.
  • In addition, this rule finalizes updates to the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI, as well as updates to the ESRD Quality Incentive Program (ESRD QIP), including for payment years (PYs) 2019, 2020, and 2021, under which payment incentives are made to dialysis facilities to improve the quality of care that they provide.

The ESRD PPS rule is one of several rules for calendar year (CY) 2018 that reflect a broader Administration-wide strategy to support the patient-doctor relationship in health care and promote flexibility and innovation in the delivery of care.

CMS is committed to transforming the health care delivery system – and the Medicare program – by putting a strong focus on patient-centered care, so providers can direct their time and resources to patients and improve outcomes.

To know about the changes read the complete text https://www.cms.gov/newsroom/fact-sheets/cms-updates-policies-and-payment-rates-end-stage-renal-disease-prospective-payment-system-quality

CMS release ESRD/DMEPOS Competitive Bidding Program Temporary Gap Period Announcement for 2019

Centers for Medicare & Medicaid Services (CMS) has released its final End-Stage Renal Disease (ESRD)/ Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) rule, which contain some, but not all of the additional competitive bidding and reimbursement reforms for which HME stakeholders have been calling.

On November 1, 2018, the Centers for Medicare & Medicaid Services issued a final rule that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2019.

  1. This rule also updates the acute kidney injury dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI, and finalizes changes to the ESRD Quality Incentive Program.
  2. The policies in this final rule aim to increase access to items and services for patients, drive competition, increase affordability, encourage facilities to adopt transformative and innovative therapies, and reward ‘out of the box’ ideas that will produce long-term savings that can be passed on to patients.

This rule also finalizes changes to bidding and pricing methodologies under the:

  • Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
  • Competitive Bidding Program (CBP);
  • Adjustments to DMEPOS Fee Schedule amounts using information from competitive bidding for items furnished on or after January 1, 2019.
  • New payment classes for oxygen and oxygen equipment and a new methodology for ensuring budget neutrality for oxygen payment classes; and special payment rules for innovative multi-function ventilators or ventilators that perform functions of DME.

Starting January 1, 2019, there will be a temporary gap period in the entire DMEPOS CBP that CMS expects will last until December 31, 2020. During that time, Medicare beneficiaries may receive DMEPOS items from any Medicare enrolled DMEPOS supplier and in most cases, they won’t need to switch suppliers.

In addition, in the proposed rule, CMS solicited comments in a request for information (RFI) on the gap-filling process for establishing fees for new DMEPOS items.

Footnotes:

CMS is committed to transforming the healthcare delivery system and the Medicare program by putting a strong focus on patient-centered care, so providers can direct their time and resources to patients and improve outcomes. The ESRD PPS and QIP DMEPOS final rule is one of several rules for calendar year (FY) 2019 that reflect a broader Administration-wide strategy to relieve regulatory burdens for providers, support the patient-doctor relationship in healthcare, and promote transparency, flexibility, and innovation in the delivery of care.

In this final rule, CMS summarizes comments it received in response to an information solicitation on how the gap-filling process could be revised in a way that complies with the exclusive statutory payment rules for DMEPOS, but also prevents excessive overpayments or underpayments for new technology items and services.

We encourage you to reach us if you have any questions at support@wonderws.com

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Is a Merger or Acquisition Right For Your Business Strategy? https://wws.wonderws.com/2018/10/15/merger-acquisition-right-business-strategy/ https://wws.wonderws.com/2018/10/15/merger-acquisition-right-business-strategy/#respond Mon, 15 Oct 2018 17:10:42 +0000 http://www.wonderws.com/?p=7961 Mergers and acquisitions have become a reality in today’s increasingly competitive home medical equipment marketplace. This means smart providers need to understand How M&As work, and how they might ultimately fit into their business strategies?

Times are tough for smaller DME suppliers, but the changing healthcare landscape is also impacting larger entities.  Rising costs and shrinking reimbursements are part of the problem, but suppliers are also subjected to the vagaries of changing and even conflicting policies between Medicaid and MCOs (Managed Care Organizations).

The post is about why mergers and acquisitions provide solutions for durable medical equipment suppliers, taking some of the heat off in a challenging market.

Bigger Is Better

It’s unfortunate to note that the laws of the jungle apply in a market like the one we’re operating in, with big fish eating little fish in a system which has emphasized cost-cutting through competitive bidding.

In the case of DMEPOS (durable medical equipment, prosthetics, and orthotics supplies), a competitive bidding process is now in place but not everywhere.  The intention of the legislation behind CBAs (competitive bid areas) was to improve access and affordability for end users, but the impact on suppliers has been substantial.

Winners in CBA bids offer not only the lowest price but meet certain criteria for quality. Larger companies are better equipped to do this, with the ability to absorb pricing which proves less sustainable for smaller companies.

This is where bigger is better, as the offer to merge with a larger entity allows the smaller fish to survive, albeit in a new configuration.  Smaller suppliers augment their market presence and are enabled to offer a higher quality of care for the patients they serve, both old and new.

Mergers of this nature benefit both parties, allowing the larger company to benefit from the network of the smaller acquisition and the smaller company to benefit from the streamlined processes and market viability of its new mothership.

The Wave of the Future

Healthcare reform is ongoing and that’s unlikely to change for the foreseeable future.  As new challenges arise, this reality will further impact smaller suppliers, sending them into the arms of the DME industry’s big fish.

When going out of business isn’t an option, merging with a larger entity is an attractive option. While it may seem as though something has been lost, it must be remembered that something has also been gained.

Joining the ranks of a larger company serves to maintain existing legacy while benefiting the people who’ve worked to create it and adding value to the DME market with improved quality and patient service.

The sector has enjoyed steady growth in recent years, as well as an uptick in mergers and acquisitions, with names like Johnson & Johnson acquiring smaller suppliers, expanding their market share and creating new synergies which benefit patients.

Contact Us or Schedule a live demo http://localhost/main-site-update/live-demo/ to find out more.

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How Do I Get Authorize to Sell DME and Bill Medicare? https://wws.wonderws.com/2018/09/26/get-authorize-sell-dme-bill-medicare/ https://wws.wonderws.com/2018/09/26/get-authorize-sell-dme-bill-medicare/#respond Wed, 26 Sep 2018 14:30:40 +0000 http://www.wonderws.com/?p=7872 According to the United States Department of Labor, employment in the medical equipment industry is expected to increase by 27 percent between 2008 and 2018. The demand for durable medical equipment is not going to slow down any time soon.

Items you will need
  • Taxpayer identification number
  • National provider identifier
  • Bank account information
  • Form CMS-588
  • NSC number, provider transaction access number or Medicare identification number (if already enrolled)

Take a visit to the National Plan and Provider Enumeration System website and apply for a user ID and password.

Check your email for an approval notification from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. After you have received notification that you have been granted approval via email by CMS, go to the next step.

  • Visit the Medicare Enrollment for Providers and Suppliers,
  • Medicare Provider Enrollment, Chain and Ownership System, or PECOS, website.
  • Log in, download and fill out the security consent form

The security consent form contains separate areas and signature requirements for the supplier organization and employer organization. The data you enter in both sections should be the same if you are requesting approval to submit the enrollment applications, and you are an authorized official employed by the supplier organization. Sign and date the security consent form in both places and mail it to the CMS External User Services Help Desk.

  • Check your email for notification that your security consent request has been approved.
  • Log in to the Internet-based PECOS system and fill out the enrollment application form CMS-855. Click “Continue” and follow the on-screen prompts to complete the application
  • Print a copy of the enrollment application for your records.
  • Mail any supporting documentation as recommended by PECOS.
  • Print, date and sign the certification statement and mail it to the National Supplier Clearinghouse – Medicare Administrative Contractor within one week.
  • Check your email for a notification that your Medicare supplier form enrollment application form was successfully transmitted online.

Wait at least 15 days, then log in to the PECOS system to check the status of your application. If you have supporting documents to mail, count 15 days after you have mailed those documents before you check the status of your application.

Points
  • You must be an authorized official of the organization you want to register as a Medicare supplier to complete these steps.
  • Allow several weeks to complete the enrollment process. Alternately, you could fill out the paper version of the Medicare enrollment application, form CMS-855S, in lieu of applying online.

CMS recommends users change their PECOS password at least once a year.

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DME Suppliers: Ensuring Access To Medicaid for Dual Eligible Beneficiaries https://wws.wonderws.com/2018/08/27/dme-suppliers-access-medicaid-dual-eligible-beneficiaries/ https://wws.wonderws.com/2018/08/27/dme-suppliers-access-medicaid-dual-eligible-beneficiaries/#respond Mon, 27 Aug 2018 13:00:16 +0000 http://www.wonderws.com/?p=7665 Dual Eligible Beneficiaries may face special obstacles when they try to access services, such as durable
medical equipment, that is covered to varying degrees by both Medicare and Medicaid.

The Integrated Care Resource Center recently released a briefing titled “Facilitating Access to Medicaid Durable Medical Equipment for Dually Eligible Beneficiaries in the Fee-for-Service System.” As the title states, the brief explores the approaches of Connecticut, California, and Illinois in ensuring dual-eligible beneficiaries receive the medical equipment they need.

⇒ Beneficiaries who are dually eligible for Medicare and Medicaid often experience difficulties accessing
durable medical equipment such as wheelchairs, in a timely manner. Whether Medicare or
Medicaid covers a specific item may be unclear.

To address this issue, some states, such as Illinois, California, and Connecticut, have developed procedures for provisional prior authorization from Medicaid for such items. States may supplement these procedures by posting lists of DME items that Medicare consistently denies as non covered, and allow DME suppliers to bill Medicaid directly for these items without first billing Medicare. This can make it more likely that suppliers will provide DME to dually eligible beneficiaries in a timely way, with less confusion and uncertainty about who will pay and when.

Policies Implemented by the Three States:

Currently, fourteen states have implemented provisional prior authorization policies supported by lists of DME items that Medicare does not generally cover. The ICRC explored the policies of three states to better understand how PA improves access for dual-eligible individuals.

California, Connecticut, and Illinois have slightly different DME billing policies. California and Illinois both implemented a feature that further facilitates the provisional PA approach. Each maintains an online list of DME items that Medicare generally denies as non-covered under Part B, but that Medicaid may cover. When it is clear from the list that Medicare will not cover the item, DME suppliers can submit their claims directly to Medicaid without first submitting them for a Medicare denial. In contrast, Connecticut developed a system that allows for prior authorization of DME before a Medicare denial.

Illinois’ Approach to DME Delivery

Illinois Medicaid simplifies the adjudication and payment of DME claims for dually eligible beneficiaries by enabling providers to use:

  1.  An online information system called Medical Electronic Data Interchange that lets providers
    verify multiple elements of a beneficiary’s eligibility, including QMB status.
  2. An online table for providers that specifies the services/items for which providers and suppliers can bill Medicaid directly because Medicare generally does not cover them under Part B. 
Online table for DME providers:

Illinois currently maintains a table on its website that indicates whether Medicare normally covers a specified DME item. 

HIPAA Description  PA Required Medicare Covered Max Quantity Max Days
A4213 Syringe, Sterile, 20cc or Greater, Each No No 15 30
A6250 Skin Sealants, Protectants, Moisturizers, Any Type Yes No N/A N/A
A7007 Large Volume Nebulizer, Disposable Unfilled, Used w/AE No No 2 30
E1300 Whirlpool, Over Tub Type, Portable Yes No N/A N/A
California’s Approach to DME Delivery:

As in all states, the California Medicaid program (called Medi-Cal) requires that DME suppliers submit most
claims for dually eligible beneficiaries to the appropriate Medicare carrier or fiscal intermediary so they can
process the Medicare benefit first. However, providers are allowed to submit claims directly to Medi-Cal
when any of the following criteria apply:

  • Medicare does not cover the item or service;
  • The beneficiary’s Medicare benefits have been exhausted; or
  • Medicare has denied the claim, or the recipient is not Medicare-eligible.
Online Table of HCPCS codes for DME Coverage:
Codes Description When to bill Medi-cal directly
A9273, A9274, A9279, A9281, E0240 – E0245, E0273, E0625 DME Always
E0970, E079, E1065, E1091, K0740, K0872 – K0876, K0881 – K0883, K0887 – K0889, K0892 – K0898 DME On the UB-04, if the facility type code is other than 33 (Home Health – Outpatient) or 14, 24, 34, 44, 54, 64, 74, 75 or 89. On the CMS-1500, if the Place of Service Code is other than 12 (Home) or 99 (Other)
Connecticut’s Approach to DME Delivery;

Connecticut began to operate its Medicaid program HUSKY Health through a self-insured, managed FFS
model in 2012. The Connecticut Department of Social Services has contracts with Administrative Service
Organizations for medical, behavioral, and dental health services as well as non-emergency
medical transportation. Community Health Network of Connecticut is the ASO that administers all
medical services, including DME.

Recent Federal Developments:

Two recent developments at the federal level may make it easier for states to provide prior authorization for Medicaid DME when Medicare may also cover the item:

1. Earlier Medicare authorization of some types of power wheelchairs. As of July 2017, a new Medicare prior authorization process is in effect nationwide for two types of power wheelchairs that may make the authorization process easier for dually eligible beneficiaries and power wheelchair providers by enabling them to get an earlier Medicare decision on those DME items.

Beginning September 1, 2018, 31 additional power mobility device codes will be subject to required prior authorization. These items are currently included in the Prior Authorization of Power Mobility Devices Demonstration, which is scheduled to end on August 31, 2018.

2. New incentive for states to develop lists of DME that Medicare will not cover. A new federal law,
effective January 1, 2018, limits federal matching payment for Medicaid DME that is jointly covered by Medicare to the amount Medicare would have paid, in the aggregate, for those items. This limitation does not apply to items of DME that Medicaid covers but Medicare does not.

Schedule a free online demo for more information http://localhost/main-site-update/live-demo/

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How Claims Audit Can Make You Sick https://wws.wonderws.com/2018/08/22/claims-audit-ready/ https://wws.wonderws.com/2018/08/22/claims-audit-ready/#respond Wed, 22 Aug 2018 16:20:19 +0000 http://www.wonderws.com/?p=7657 How To Make Your CLAIM AUDIT Look Like A Million Bucks?

HME businesses face increasing numbers of pre- and post-payment audits, which can be very stressful and costly events. Without a sound strategy for maintaining accurate and retrievable documentation, an audit request can disrupt operations and put your organization at financial risk.

When an audit strikes, the response must be swift and precise. The best approach to an audit letter is a quick response with proof that all documentation complies with requirements.

Five steps HME providers can take to give a speedy response and make sure all claims are audit-ready include:

1. Give Customer Service Representatives tools to improve intake:
  • Knowledgeable customer service representatives at the front end are essential to collecting the right information at the start of service, but staff turnover and constantly changing requirements make it difficult to keep CSRs up-to-date on payer requirements.
  • Technology can fill the knowledge gap if it does more than just park the data in a form prompting CSRs to collect specific documentation, which enables correction of the claim before it is filed.
2. Document to payer-specific rules:
  • Improve efficiency by helping CSRs collect payer-specific requirements through established validation rules.
  • While Medicare rules may call for a document to support specific Healthcare Common Procedure Coding System (HCPCS) codes, other payers may have a looser set of rules for that procedural code, which don’t require the same level of documentation saving time for the CSR.
3. Enable quick response to the audit letter:
  • Staff should be able to quickly access the documentation when responding to an audit letter, which is not always easy in the case of long-term service.
  • Establishing a link between billing records and the sales order documentation eliminates the risk of error when pulling documentation and ensures the information can be gathered efficiently.
  • In addition, advanced HME systems allow users to collect, submit and track documentation electronically in response to CMS audits.
4. Automate document review within the workflow:
  • There are times a critically needed product must be delivered before documentation is complete.
  • This increases the need for a careful documentation review before submission of the claim to ensure progress notes support medical need and meet requirements.
  • HME providers can easily determine whether or not to delay confirmation of a claim until the file is complete and the claim is substantiated by automating the review process throughout the workflow, utilizing optical character recognition technology and installing checkpoints that alert staff to missing or inaccurate information.
5. Capture data on all patient-care related interactions:
  • Setting up a process to capture all telephone calls to patients, verbal orders from physicians or communication with other providers is critical, but difficult with the number of people involved in each case.
  • Technology that documents actions by time, date and personnel involved provides additional support as an HME provider demonstrates compliance with billing requirements.

There’s no sure way to guarantee you won’t go through an audit; however, by ensuring the good HME business technology is in place you can take on most any audit challenge. With proactive compliance and timely response submission, audits can be resolved and claims are paid faster leading to improved cash flow.

Don’t wait for an audit Make every claim audit-proof from the start and For more information email us at support@wonderws.com

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Medicare Documentation Guidelines For Durable Medical Equipment https://wws.wonderws.com/2018/08/15/dme-medicare-documentation-avoid-denials/ https://wws.wonderws.com/2018/08/15/dme-medicare-documentation-avoid-denials/#respond Wed, 15 Aug 2018 14:00:52 +0000 http://www.wonderws.com/?p=7629 The Centre for Medicare and Medicaid Services offers extensive and detailed DME Medicare documentation guidelines in general, as well as other guidelines for documentation that can be found in Local Coverage Determinations and National Coverage Determinations.

Durable Medical Equipment billing continues to scrutinized by Medicare and other Commercial Carriers, so everyone needs to understand DME Documentation Requirements. Without understanding and following documentation requirements, You’re putting your office at risk  to fail an audit.

Not only that, but you face refunding an insurance carrier or CMS, which would be an unfortunate and unnecessary revenue loss for your practice. It’s important to learn about the complicated documentation requirements for DME from a general rules perspective as well as what is needed for specific kinds of DME.

1.  Medical Necessity 

The lengthy documentation process for DMEs includes a paper trait that heavily supports medical necessity of the DME and for the suppliers that require prior approval, a provider prescription and clinical documentation are necessary and must support this requirement.

Medicare requires a prescription before approving payment for any DME. This prescription may originate with a physical therapist starting the documentation process and an approved physician providing the prescription.

Communication is key, as the script and supporting documentation need to prove medical necessity, In doing so, the following information is required.

  1. Licensed provider’s plan of treatment.
  2. Anticipated benefits and outcomes from using the DME.
  3. Detailed member’s clinical and functional status so that a determination of medical necessity can be made.
  4. Patient’s medical record.
2. Avoid Insufficient Documentation Errors

If any condition of payment is missing, including just one physician signature, your claim is at risk to fall into the insufficient documentation error category, which has the potential to prolong payment or cause a denial.

Beware: Your claim could fall in this error category if the reviewer couldn’t conclude that some allowed services were actually provided at the level billed, or were medically necessary.

Here’s how to avoid insufficient documentation error for DME:

  • Check  which DME Healthcare Common Procedure Coding System (HCPCS) codes require a valid detailed written order.
  • Make certain the physician’s National Provider Identifier is on the valid detailed written order.
  • Know that Medicare will pay claims for DME only if the ordering physician and DME supplier are actively enrolled in Medicare on the date of service.
  • As a condition of payment, be sure that a physician, Physician Assistant, Nurse Practitioner documents a face to face encounter examination with a beneficiary in the 6 months prior to the written order for certain items of DME.
3. Document Confidently

When dealing with payment denials, you need to get up to speed on:

  • Understanding the latest policies from major insurance carriers on pre – authorization requirements.
  • Using the right modifiers to confirm you have the proper documentation needed for reimbursement.
  • Comprehending advanced beneficiary notices for Medicare  and Commercial insurance carriers.
  • Knowing what proof of delivery rules you should be following.

DME items are not professional services, your practice is purchasing the equipment in hopes that you will receive a profit in return. DME present a particular challenge when it comes to payment.

If you are audited and don’t have  proper documentation, your organization will have to give that money back and possibly be penalized. So it’s time to get your DME documentation ducks in a row.

Schedule a free demo to know more about on DME Medicare Documentation http://localhost/main-site-update/free-practice-analysis/

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How Do ERP Software Work in DME? https://wws.wonderws.com/2018/04/02/erp-software-dme/ https://wws.wonderws.com/2018/04/02/erp-software-dme/#respond Mon, 02 Apr 2018 12:40:44 +0000 http://www.wonderws.com/?p=6991 Medical devices are a fast-growing segment in the health care industry. The demand for devices is accelerating from two particular areas, emerging foreign markets where the devices are relatively new, and in the U.S. with its aging population.

Medical devices manufacturers face unique challenges when compared to other equipment manufacturers. Not only do they face the product complexity, the demand for more variety by customers, the competitive pressures, and the downward price pressures; they also face the following unique complexities.

What is ERP?

Enterprise Resource Planning software works across many functions of the business.

For example, inventory. Purchasing orders from a vendor are created and sent electronically once products come in they will enter into the ERP so that all products are accounted for in real-time, and with their actual costs and bar, code systems keep the inventory up to date, so that products can be ordered on a just-in-time basis.

Benefits of ERP Software:

  • Easy to comply and track all regulation and compliance requirements
  • Improve life cycle management
  • Complete product and component traceability, serial no., batch/lot, component
  • Improved collaboration and relationship with the doctors, medical experts, engineers, and suppliers
  • Ability to handle multiple planning models, configurations
  • Lower costs and waste thru lean practices
  • Flexibility in adapting products to specific customer wishes
  • Better control over design changes
  • Ease of doing business for the customer
  • Insights into accurate product cost with full view and application methods
  • Manage high-level receivables

ERP can bring the inventory into each individual delivery truck, enabling the truck drivers to track inventory and always have items on hand. In this way, ERP turns trucks into mobile warehouses, and drivers become responsible for their own inventory.

A second trip to deliver to a patient costs on average of $70. With an ERP system integrated into curbside, proper patient sizing, inoperative equipment, and compliance documents are complete and accurate.

When a customer service representative enters a customer’s information of all the critical elements maintained within the ERP system.

Once a customer profile is set up all the documentation are attached to that customer drastically increasing the efficiency on the billing operation, because the ERP is synced up with the billing and insurance information.

They can also tell customers if they have pending payments due, speeding the payment process.

Once the Patient responsibility is identified and credit card will be placed in a file automatically to collect the money when the claim is adjudicated.

If the patient cannot pay that amount on a single payment then a plan can be established at intake.

The billing team can instantly access billing records, reimbursement rates, and documentation for any individual claim. This allows them to immediately remedy problems before submitting for reimbursement.

The integration of the ERP means that the billing team has a much higher rate of accuracy when submitting claims because the system will tell them when a claim is incomplete, virtually eliminating denials based on incomplete claims.

Are you ready to see how powerful ERP software can benefit your business? Schedule your personalized, one-on-one demo http://localhost/main-site-update/live-demo/ today.

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Three Proven Growth Strategies For HME Business https://wws.wonderws.com/2018/03/28/hme-dme-growth-strategies/ https://wws.wonderws.com/2018/03/28/hme-dme-growth-strategies/#respond Wed, 28 Mar 2018 12:30:16 +0000 http://www.wonderws.com/?p=6986 As we approach the end of the year, how have you done on your sales strategy? Did you achieve your individual and company goals? Did you have a plan? Did you stick with it? A lot of questions, but all very valid.

Many HME providers know technology can help their business. What you might be missing is finding new, fast evolving technologies that can boost your revenues, grow your business and improve your stream of referrals. The latest innovations do all this by focusing on improving business efficiency and expanding operations areas that many HMEs struggle with to achieve success.

Why do most HME providers strategic plans fail?

Most of those plans fail. Depending on which study you follow, the statistics range from a dismal 3% of companies whose executives say they are successful at executing their strategies to at best about one out of every three organizations that integrates its plans into its daily operations with high effectiveness.

Why are we so weak on strategic plan execution?

Do we treat our strategic planning like the gym membership that we all get at the beginning of each year to lose weight and get in better shape, only to quit by February?

The best time to begin a strategic planning process is between September and Mid-November. We have a great opportunity as it pertains to a strategic sales plan for our business.

What can be the most advanced technology do to help your business grow?

Here are three things you can do with the latest innovations.

1. Power of Information:
  • Information is the best resource available in the healthcare industry. With the right tools, you can harness the power of information and find solutions to the difficult answers that help your business and needs of your patient.
  • Executive DashboardProvides trending data over an extended period of time whether it’s a few months or an entire year which enables you to adjust your strategic plan.
  • Business scorecard: Provides a snapshot of where the business stands at that moment in time, and allows you to adjust your formula and sales strategy.
  • Leveraging intuitive dashboards and tracking your metrics against key performance indicators helps you gain the visibility needed to make sound business decisions and identify workflow bottlenecks, in order to increase efficiency moving forward.
2. Ready with Audit
  • HME businesses face increasing numbers of pre and post payment audits, which can be very stressful and costly.
  • Without a sound strategy and technology platform for maintaining accurate and retrievable documentation, an audit request can disrupt operations and put your organisation at financial risk.
  • An advanced software solution should automatically find the correct documents and add them to each claim, as well as send audit responses using the latest esMD protocols.
  • Beyond improving efficiency, the right technology can help providers maintain a strong cash flow by resolving audits quickly and accurately.
3. Build Stronger Relationships
  • Referrals are the heart of any HME business. It is hard work to establish productive relationships with referral sources and keep them engaged with you long term.
  • More and more referral sources are embracing the transmission of electronic referrals through their EHR system.
  • In the near future, physicians may opt to only send referrals to providers who are equipped to accept e-Referrals, request e Signatures, and automatically share patient data and outcomes easily.
  • HME providers that implement a strong technology platform will be most prepared to succeed in this new interconnected world.

The best run companies have the hardest time growing. Building a process for monitoring your external environment and developing strategies based on that analysis can help position your business for sustainable growth.

To help you through this process schedule a free demo now!

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