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

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.

It is important for you to take charge of getting your DME.  You know best what you need and it is your responsibility to make sure you get equipment that will work for you. This process can go more smoothly if you attend to the details

1. Who can get DME?
2. What are the steps in getting DME paid for?
3. What are the most common reasons for denial of payment?

What is Durable Medical Equipment?

According to the Centers for Medicare and Medicaid Services, is a health care device that helps a person with a mobility limitation to conduct activities in their home and community.  This includes such items as wheelchairs, walkers, oxygen tanks, communication devices and hospital beds. The Centers for Medicare and Medicaid Services defines durable medical equipment  as any equipment that:

1. Can withstand repeated use
2. Is not useful to a person who does not have an illness or injury
3. Is appropriate for use in the patient’s home

It’s strange how they think we are all sick and stuck at home, and that getting around is a medical issue!

What Are Some Examples of DME?

 DME is considered to include:           

• Equipment that can help you to get around more easily such as canes, crutches, walkers, wheelchairs or scooters.
• Equipment that you may need to care for yourself at home such as hospital beds, raised toilet seats, oxygen tanks, or machines that make breathing easier.
• Equipment that can help you to hear or see better like hearing aids or magnifiers.

DME does NOT include:

• Equipment that is considered “items of personal convenience” or reusable items, such as rubber gloves, catheter tubing, or irrigation kits.
• Equipment that is not considered to be for “medical use,” such as grab bars, lifts or shower chairs.
• Equipment used exclusively outside of the home is often labeled recreational or “used to pursue leisure interests” and may not be covered as DME.

So getting around is a medical issue, but taking a shower is not?? Who writes these regulations?

Who can get DME?

People who are admitted to hospitals and skilled nursing facilities for surgeries, illnesses or injuries will get the equipment they need before being discharged.  In these situations, the equipment that people receive depends on why they were in the hospital. For example, if you go to a hospital for a hip replacement, the hospital will probably send you home with a walker and a raised toilet seat.

The process for getting DME without being in the hospital is different. You can pay for any piece of durable medical equipment yourself. However, because it can be expensive, people usually use their health insurance to pay for DME. Insurance carriers have different guidelines for what equipment they will pay for.  For example:

Medicare pays for DME when you:

1. have Medicare part B;
2. have a doctor prescribe a covered item of DME; and
3. need the device in order to function in your home.

How Do You Get The DME You Need?

Once you have decide that DME is the right choice for you, there are several steps involved in getting it.  If you are able to pay for the equipment yourself, you can go to any DME vendor in your area that has the equipment you would like and you can purchase it.  Depending on whether it’s in stock and available, you may be able to pick up the DME immediately or usually within several weeks. Follow these steps to get your DME.

What is a DME vendor?

A DME vendor is a company that specializes in DME.  DME vendors have staff who are experts in equipment. Some are physical therapists (PT), occupational therapists (OT) and Certified rehabilitation technology suppliers. The vendors work with the companies that make the equipment as well as your insurance carrier.        

How do you find a DME vendor?

Your health insurance carrier may allow you to choose your own DME vendor. However, your insurance company may have a recommended DME vendor, and they may only pay for equipment you get through this vendor. Many times the DME vendor who has the contract for your insurance may not be the best qualified to handle your needs. Ask your insurance carrier what you may do if you are not satisfied with their vendor. You are the consumer!

If you have a choice of vendor:

1. Your doctor can recommend a DME vendor.
2. Ask your friends if they can recommend a DME vendor in your area.
3. Telephone your local drug store, pharmacy or medical supply company and ask if they know of DME vendors in your area.

Who Follows Up On Your Order?

You do. To make sure everything has been filed and the process is going smoothly, you should follow up with your DME vendor. Remember, they handle hundreds of requests so you also will want to follow up with Medicare, Medicaid or your private insurance company directly to check on the status of your claim.

You should keep a copy of every form filed with your request and get any claim numbers and all contact information. Make sure your doctor knows also how long the process is taking and what is happening so that he/she will be able to assist you in following up when necessary.

Conclusion: 

Getting the right gear for your unique needs can be a challenging and time consuming process.  Using the information provided here and attending to the details can help make the process go a little more smoothly and reduce the chance of having your request denied.  It is important that you take charge of getting your DME. It is your responsibility to make sure you get the right gear.

If you need any help in contacting DME Vendors Contact us. Our team will guide and support you with selecting of right DME suppliers for your Medical issues.

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.

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. 

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:

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/

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/

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 Dashboard: Provides 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!

Today’s growth oriented HME provider realises that they simply can’t do it all and still maintains focus on the essential functions of a patient-focused business. Letting go is hard, but smarter HME have reaped tremendous benefits from outsourcing the more administrative parts of their business operations.

The HME outsourcing areas of the operations such as:

• Billing and A/R management
• Intake
• Resupply
• Business analytics

Have the below keys for successful outsourcing:

• Learn how to use operational assessments to define business objectives and identify non-core business functions that are limiting your growth.
• See how to define outsourcing success in terms of operational gains, cost‐savings and
• Understand the requirements for a successful outsourcing partnership

What Processes Could You Outsource?

1. Insurance Billing & Collections
2. Patient Billing & Collections
3. Resupply Patient Contact

What are the Reasons to Consider Outsourcing?

• Focus on your core competency of growing your business.
• Reduction in overhead of staff management, recruitment and on‐going training.
• Variable expense when compared to fixed expense from in‐house staffing.
• Improved processes through best practice utilization.
• Access to consistent informational reporting.
• Staff to accommodate variable demand.
• Billing expertise in new product categories.
• Flexibility in pricing with various fee structures to align fee structure to your business: Flat‐Fee Pricing, % of Collections, Hybrid.

Set a Proper Expectations

• What is a fair stabilisation period when outsourcing?
• What level of communication & reporting should I expect from an outsource vendor?
• Which type of improvement should I expect when outsourcing my Revenue Cycle Management
• What should I expect to gain from outsourcing patient contact, like resupply calls
• Should I be nervous to have an outsource vendor contacting my referral source?

How to Measure the Success of Outsourcing

⇒ Set clear and measurable targets

⇒ Monitor performance closely:

• Managing by the checkbook balance no longer works
• Ensure an open line of communication with your outsource partner

⇒ Develop reporting to clearly measure:

• Overall performance trend
• Exception identification & issue resolution

⇒ Meet regularly to review performance

Myths & Realities of Outsourcing

Lack of control over my billing department

• Hold billing partner accountable
• Set performance goals and monitor it regularly

Lack of visibility into what is happening to my AR 

Depending on your platform and outsource partner, outsourced workflow should be completely transparent

They will only collect the low‐hanging fruit.

• Set expectations on informational reporting
• Compare against pre‐outsourcing performance

Key Business Benefits from Outsourcing

• Implement best practice billing processes
• Manage to your business key performance indicators
• Improve DSO and accounts receivable aging
• Improve collections to billing ratio
• Post payments and adjustments accurately
• Ensure compliance of filed claims through random monthly audits
• Minimize denials and write offs

Conclusions

Outsourcing can make sense from an overall business strategy. Do a cost of benefit analysis using the model discussed to consider options. Explore options in the marketplace and remember that cheaper is not always better.Doing all this can help ensure that the whole outsourcing process is satisfactory for you and profitable for your business.

Billing services are a great way to free up your time so you can see more patients while increasing overall revenue. Request a free demo to learn more about your HME Outsourcing.