With WWS your facility will be able to:

Keep patients in a compliant and billable status.

Keeping patients in a compliant and billable status is important for all healthcare providers, but it’s especially so for those who rely on payors to pay their claims. If you’re not following your payor requirements, you risk losing money on every claim that goes unpaid. These costs can quickly add up and cause serious financial strain on your practice or health system.

By using the right tools, you can keep your patients in a compliant and billable status by:

• Keeping up with insurance company requirements for renewal & expired Prior Authorization.

WWS’s unique approach to managing Prior Authorization is beneficial to DME providers. With WWS, you can save time by not uploading the same documents over and over again, and you can avoid redundant administrative work by using our secure electronic transfer of documents. giving you the ability and time to focus on patient care or other important tasks.

• Increased workload for administrative staff
• Reduced ability to attract and retain business opportunities 
• Reductions in reimbursement from government and private payers

• WWS saves you time by not having you upload the same documents over and over again. We gather all of your documentation in one place, so it’s ready when your payor requests it. This means less work for you!
• Serve ensures that you get paid for the services you provide by working with many different payers and helping them understand how much they should be paying for your services or products in order to create accurate claims, which leads to quicker payment cycles—meaning more money in the bank!

Conclusion

We think the best part of the WWS approach is that it saves you time and effort with its automatic uploads and real-time updates. It’s a simple, elegant solution for a problem that many healthcare providers don’t even know they have. We believe that when it comes to revenue cycle management, this kind of innovation can make all the difference—not just in your bottom line, but also in your ability to provide quality care to patients who need it most. If you want more information about how WWS can help you increase your collections while reducing administrative costs, we encourage you to reach out today.

What is patient eligibility?

Eligibility simply refers to a patient’s right to receive healthcare benefits. When you sign up for a new healthcare plan, you will be asked to provide information about yourself including your age, date of birth, current address, etc. Based on this information, your insurance company will determine your patient eligibility, that is, what healthcare services you are entitled to receive as a patient. If you are eligible for services, your insurance company will determine the amount of money you have to pay out of pocket for your healthcare services. If you are not eligible for services, you will not receive any healthcare coverage.

Eligibility for in-network services and providers

Every insurance plan offers a network of healthcare providers and services. This means that you will only be offered a selection of vetted healthcare providers, such as medical doctors, specialists, surgical facilities, and pharmacies nearby your home address. The network is made up of healthcare providers who have agreed to offer services to patients at a certain rate. This rate is often lower than the standard rates offered outside of a network. While in-network services and providers are provided at a lower rate, if you decide to visit an out-of-network provider you will have to pay the entire cost out of pocket. This is because your insurance company will not reimburse you for services you receive outside of your network.

Eligibility for out-of-network benefits

Some insurance plans will offer you out-of-network benefits even if you decide to visit an in-network provider. This means you will still be able to be reimbursed for services received at an out-of-network provider. However, you will pay a higher out-of-network fee than if you had received the service in-network. You will also have to submit a claim to your insurance company and wait for them to approve your claim before receiving reimbursement. Depending on your insurance plan, you might be allowed to visit an out-of-network provider after a certain period of time has passed. This is known as a “waiting period.” You will have to pay the full cost of the service out of pocket until your insurance company approves your claim.

Understanding your plan’s deductible

A deductible is the amount you have to pay out of pocket before your insurance company begins to reimburse you. As a patient, you will have to pay this amount every year before your insurance company will start paying you back. After you have paid your annual deductible, your insurance company will begin to reimburse you for any expenses you have incurred. Depending on your insurance plan, you might have multiple deductibles, that is, one for in-network and one for out-of-network services. With some insurance plans, after you have paid your deductible for in-network services, you will only pay a coinsurance rate for the remainder of the year. With others, you will continue to pay a coinsurance rate for out-of-network services.

Understanding your co-pays

A co-pay is the amount you have to pay for a specific service at the time of treatment. These services include visits to the doctor, medical tests, or prescriptions. Depending on your insurance plan, you might have to pay different co-pays for different services. Depending on what your insurance plan requires, you might have to pay a co-pay at the time of service or you might have to pay a co-pay at the end of the year. At the end of the year, you will have to pay the total amount of all the co-pays you have accrued over the course of the year.

Summary

When it comes to healthcare benefits and eligibility, the more you know, the better. Understanding your eligibility, what your plan offers, and how you can use it to your advantage is essential. It will also help you better understand what sort of healthcare options are available to you, how much they cost, and whether or not you qualify for certain services.

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1. Create Patient-Friendly Medical Billing Statements

Although medical practices and hospitals are aware of the complexities of the medical billing process, patients are likely to be perplexed. Industry expectations have shifted in such a way that providers must now take a patient-centered approach to this process, so it’s more important than ever to educate yourself on how to remain accessible.

2. Maintain a clean claim rate of at least 95%.

The clean claim ratio of your medical practice is the average number of claims paid on the first submission. In an ideal world, every provider would like to achieve a percentage greater than 95 percent, but the meaning behind the number is what truly matters. The higher your clean claim rate, the less time your staff will spend attempting to identify denial reasons, coordinate payments, and re-submit claims.

3. Don’t Ignore Payer Reimbursements Analysis

Many medical practices place too much trust in payers to reimburse them in full for every claim they submit. Regrettably, this is not always the case. Underpayments are more common than you may believe. Devoting resources to analyzing payment accuracy will reduce revenue loss while providing valuable insight into your practice’s revenue management cycle data.

4. Take Control of Your Accounts Receivable

How frequently do you keep track of your receivables? Do you find yourself pressed for time to respond to a denied claim? Perhaps you should reconsider how you handle contracts and receivables. Coding changes occur quickly in the healthcare industry, and there is no better time to prepare for potential issues.

5. Return to the Fundamentals of Revenue Cycle Management

Are you brand new to revenue cycle management? The first step is to have a consistent cash flow. Even if you’re well-versed in the complexities of medical billing and coding, it’s always a good idea to review your basic best practices to ensure you haven’t deviated from the path.

6. Submit Complete and Accurate Claims

Making sure your medical billing is correct the first time you submit it can save you the time and effort of editing and resubmitting incorrect claims. It is estimated that up to 80% of medical bills contain errors, resulting in weeks of editing, resubmission, and provider’s not receiving payment. Filling out claims correctly and avoiding common errors, such as incorrect patient or insurance information and duplicate claims, can help your medical practice have an efficient medical billing process.

7. Maintain Knowledge of Medical Billing Rules and Regulations

It is critical to be aware of the current medical billing rules in order to ensure best practices in medical billing and coding. Because regulations are constantly changing, staying informed can result in a more efficient process that avoids rejections and medical billing edits. Failure to stay current on medical billing rules can have a direct impact on the cash flow of your medical practice.

8. Always look for opportunities to improve.

Finding ways to improve will continue to help your healthcare practice grow. Because the healthcare industry is constantly changing, looking for ways to optimize the medical billing process on a consistent basis will help to maximize revenue. Aside from staying up to date on current medical billing regulations, tracking performance is critical for identifying inefficiencies and optimizing efficiency. Key performance indicators (KPIs) can help measure the accuracy and efficiency of previous performances and identify areas for improvement.

5 Medical Billing Tips for Your Healthcare Practice

• File claims on a daily basis
• Collect copayments at the point of service.
• Verify and update the patient’s insurance
• Keep track of unpaid claims and follow up on them.
• Make EOBs your friends

 It is common to find a provider with excessive amounts in medical AR that are more than 180 days outstanding unless specific and consistent active accounts receivable follow up on current billings is initiated.

 The volume of outstanding medical claims, as well as the time required to research, correct, appeal, and/or re-file the medical claims, will usually take much longer than anticipated. A small number of people devoted to this task will not be able to achieve the goal by significantly reducing/eliminating the claims. So outstanding AR teams will be able to collect as much money as possible in a short period of time.

Why is it Necessary to Have an AR Management Team for Healthcare Services?

In a healthcare organization, the accounts receivable follow-up team is in charge of investigating denied claims and reopening them in order to receive the maximum reimbursement from Medical insurance companies. Billing professionals with specialized skill sets are now required to handle AR follow-ups.

It should be noted that, in addition to AR follow-ups, several other critical processes, such as charge entry, verification, and payment posting, must be completed first. A medical billing specialist determines the exact procedure code and diagnosis code based on the treatment plan during these procedures. There is a chance that the medical insurance company will deny claims if they do not follow the rules; therefore, having a dedicated AR Management team who can follow-up with the Medical insurance firm to resolve your denied claims is critical.

Six Reasons Why AR Follow-up Is Critical in the Medical Billing Process

1. Financial Stability: The financial stability of any healthcare service provider is heavily reliant on maintaining a positive cash flow. The hospital must maintain a consistent flow of revenue to cover expenses in order to provide patient care services, and the AR department ensures that this is done.

2.Aids in the Recovery of Overdue Payments: AR follow-up assists all hospitals, physicians, nursing homes, and other organizations in recovering overdue payments without difficulty. It is easier for healthcare providers to receive payments on time when there is a team that is constantly involved in the claims follow-up procedure.

3.Reduce the amount of time that outstanding accounts are allowed to remain outstanding: The primary goal of the AR management team is to reduce the amount of time that accounts are allowed to remain outstanding. The AR team monitors unpaid accounts, determines the appropriate action required to secure payment, and implements payment procedures.

4.Claims Never Go Missing: The most common reason for payment delays is the claim not being received. This usually occurs when paper claims are misplaced. To avoid this, it is best to send the claims electronically.

5.Claims that are denied can be pursued: Depending on the reason for the denial, you can actually send a new claim request with the necessary corrections made. The AR department can ensure that all claims are followed through to completion by calling the insurance companies and obtaining the denial reason rather than waiting for the denial reason to arrive in the mail.

6.Recover Claims Held Pending for Information: Claims may be held pending for a period of time due to additional information required for the member. By following up properly, the AR Management team can inform the member about the situation and then take appropriate action to speed up the process to recover claims.

WWS medical AR programme solves the problems that have traditionally stymied individual providers’ collection efforts. WWS pursues these accounts by assembling a group of professionals to “blitz” them.

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/

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.

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For every argument about sticking to your core mission, there’s a competing philosophy that says you must adapt to the times and embrace change.  Your industry and the business owners who comprise its ranks need to be open to change and re-evaluate their businesses and how they operate.

Reimbursement changes as well as technological advances, coupled with the changing styles of consumerism, how people shop, and the fact that customers are willing to pay for an increasing amount of their healthcare all make the environment ripe and ready for a change!

So, What is a DME supplier to do?  What changes are trending in the industry that you can consider? 

Here’s a list of some common and some not-so-common trends in how businesses are changing and adapting to the new reality that is healthcare:

1.  RETAIL:  

• For many years, retail was something many if not most DME organizations avoided.  Your customer service reps were too busy answering phones to wait on customers in a showroom. 
• Perhaps because you’re more likely to be spending your own money (as opposed to insurance, Medicare, etc.), folks are more willing to visit your DME stores than before. 
• Caregivers and loved ones are increasingly involved in the purchase/search for medical care, products, and supplies. 
• You’ll need staff to handle the traffic and provide customer service along with sales and you’ll need a location that is in a convenient part of town.  But, the payoff can be considerable. 
• Most DME organizations that provide retail services report that they get more traffic in their stores than in the past and the trend is increasing.

2. MAIL ORDER: 

• If you don’t think mail order services are worth investigating, consider Amazon. 
• They’ve literally changed the way America shops. 
• Malls are closing across the country because of this trend, and if you don’t believe that this method can work for healthcare, remember that Amazon is ramping up a mail order pharmacy. 
• Their delivery model is efficient and tough to compete with.  But they don’t have licenses and credentialing to provide DMEPOS and you do! 
• Mail order has become an effective way to distribute urological, enteral products, CPAP masks and supplies, diabetic testing materials, and a whole host of other products.

3. HOME MODIFICATION

• Who better than a DME that sells grab bars, bathroom safety equipment, and mobility devices to install stair glide systems, build appropriate and safe ramps for home access, and make a person’s bathroom safe for someone that has difficulty moving around?  you know the products and you often have a built-in database of potential customers. 
• Many of the same referral sources that send a patient who needs a wheelchair to a DME are also looking for a good, reliable home modification company to send new customers to.

4. SPECIALIZE:

• As DME owners, you need to constantly re-evaluate which product lines and which services are working and which aren’t.  Gone are the days that we can be “all things to all people.” 
• If your core business is respiratory products such as PAP and oxygen but you added bent metal DME and general medical supplies over the years, would it make sense to go back to your core business? 
• Bulging off product lines that are no longer profitable can help us focus our energies on products and services that are still worthwhile.

5. GENERALIZE:

• For many organizations, narrowly focusing on a specialty makes sense.  For others, however, adding additional product lines might make more sense.  If you have set up a business to deliver hospital beds, you probably have a warehouse, an area to clean and repair equipment, delivery personnel and vehicles, and customer service to answer the phones when these hospital bed customers call you with issues.  Why not put these resources to work for you in other areas?  The goal here isn’t to become all things to all people but rather to keep your staff busy, and utilize the skills and reputation you’ve developed in other, complementary areas.

The most important aspect of reinvention is to think it through.  What’s good for other DME organizations isn’t necessarily good for you!  But staying open to change and willing to consider other options can open a whole new avenue of opportunity and hopefully a better income stream.

Time to change your DME Business model. Contact us for more information +1(302) 613-1356