HME News

OCT 2018

HME News is the monthly business newspaper for home medical equipment providers. This controlled circulation publication reaches 17,100 home medical equipment services providers, including traditional HME dealers & suppliers, hospital- and pharmacy-o

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hme news / october 2018 / 11 By Wayne van Halem A s you are likely well aware by now, Medicare has transi- tioned away from widespread prepayment review and is now full speed ahead on their Targeted Probe and Educate (TPE) audit program. The key word here being "targeted." The widespread medical review audits were previously focused on procedure codes and not necessarily on providers. Any- one submitting claims for codes under review were subject to prepayment audits. Now, they pick specific suppliers to focus their audit efforts on based upon data analysis and prior error rates. s up- pliers are given three chances to pass the TPE audit. If a supplier cannot pass with an acceptable rate after three rounds of prepayment claim audits, then additional actions will occur. If they do pass in the first three phases, they will receive an audit reprieve for a year on that particu- lar code. t he much sought after audit reprieve Well…as with any audit program, con- sistency is key. Thus far, the interactions we have had with our clients and the contractors has been positive and we've seen several achieve that much sought after audit reprieve, but there have still been some bumps in the road. During a recent DME industry meeting where CM s was presenting details on this program to the audience, one industry veteran stated, "It's like we're flying in a plane while it's still being built." In essence, it's a new program that was implemented pretty quickly and exten- sively, following a relatively short pilot program (for CM s standards). c hallenges and inconsistencies o ne challenge w e h a v e s e e n includes ques- t i o n a b l e d a t a a n a l y s i s . F o r example, a cli- ent received a TPE audit in a competitive bid area (CBA) for a product that they did not win a bid for and were not billing. o ther entities with multiple PTANs have been bom- barded with multiple TPE audits at once, making it a challenge to manage the pro- cess. The analysis is currently focused on particular procedure codes, so a compa- ny can be audited on related supplies or equipment multiple times—despite that the requirements are the same (i.e. CPAP mask and CPAP tubing). These issues have been raised to CM s and they genu- inely seem committed to improving the program for suppliers. We have seen some inconsistencies from both DME MACs and individual reviewers. While this is not something new, there were some denial reasons that were identified that hadn't been previ- ously identified that created some con- fusion. Also, just like with any new pro- gram, you have inconsistencies between how the individuals participate in the program. For example, in some instanc- es, we have had reviewers that have been very communicative and forthright with information, while others have had a much more reserved approach. Hope- fully, we start seeing more of the for- mer versus the latter as people get comfortable and expectations are set by CM s . It's clear that the goal of the program is to streamline the audit process to reduce denial rates, which is a step in the right direction for everyone. p ro tips While industr y cham- pions continue to share insight and recommen- dations with CM s , there are some suggestions I can make to help you in the process. First, make sure to develop an open line of communication and estab- lish a rapport with your reviewer. In most cases, your reviewer is going to be the same throughout the course of your TPE and it will be important for you to know where you stand throughout the audit. I'd also recommend establishing a point person in your office to manage the TPE response. Don't bom- bard the reviewer with multiple people asking similar questions. At any point in the review, you should know where you stand, rather than just relying on the DME MAC. Lastly, if you disagree with a denial, explain why you do. Everyone makes mistakes and explaining why you dis- agree, in a reasonable and respectful manner, could result in fewer denials or claims getting over- turned. y ou also have appeal rights on these claims, so that is certainly an option, as well. If the claim gets overturned in the appeal process, then the reviewer should take that into consideration when deciding whether to move you on to the next phase or not. w hat's at stake? y our goal is to pass TPE re v i e w i n P h a s e 1 o r Phase 2. If you get to Phase 3, you'll need to pay even more particu- lar attention to the deni- als. Failing Phase 3 will result in a referral to CM s and, likely, a much more expansive audit or extrapolation. Also, while they have not indi- cated their intent to exer- cise this authority, CM s does have the ability to revoke the billing privileges of a sup- plier who shows a "pattern or practice" of submitting claims erroneously. With some effort, TPE can be as easy as 1, 2, 3. hme Wayne van Halem, CFE, AHFI, is president of The van Halem Group. Reach him at wayne@ By Wayne Bailey W ITH WA r P speed changes in the DME industry, it can be hard to stay ahead of the game. And if you don't, you'll find that everything from identifying your profit center to managing almost every aspect of your entire business will suffer, causing wasted time and money. If you're experiencing any of these symptoms, an enterprise resource plan- ning (E r P) system may be just what the doctor ordered: s treamline your software programs Does your business run on a number of different software systems? y ou're proba- bly using different systems for compliance documentation, sales, inventory, billing, accounting and delivery, like most DME businesses. All of these different systems running at once can sometimes hinder, not enhance, the efficiency of the process for every order. If margins are healthy, mul- tiple software systems probably work fine, but if margins are tight, efficiency counts. To make matters worse, if your software systems don't communicate with each other, you're adding more steps to the pro- cess and making it more inefficient. Time is valuable and it can't be wasted. b etter access to business information y ou're running your DME business in a competitive market, so access to accurate, up-to-the-minute information about your business is crucial. Information about average sales margins, most profitable products and accounts receivable should be at your fingertips if you expect your DME business to compete in the current market, so a single E r P platform that cov- ers inventory, delivery, billing, accounting and sales is vital. c leaner accounting o ne of the most obvious signs your busi- ness needs an E r P system is that your accounting system is slow and becoming an obstacle to efficiency. If your account- ing staff spends hours per week manually entering data about inventory and bill- ing into a paper-based system, it's time to consider measuring the wasted time and taking a hard look at what it's doing to your bottom line. Also, if preparing and printing financial reports is slow and lag- ging, you need to consider the impact that can be made with an E r P s o l u t i o n . Imagine all your financial infor- mation—billing, accounting and i n v e n t o r y — i n one database, so you spend time less time manually posting and recon- ciling information, ultimately freeing up your accounting staff to make them even more productive. i mproved inventory management At the core of every DME businesses is inventory. If you don't have the neces- sary products in the right warehouse and trucks, delivered to the right customers, your business will fail. If separate billing, sales and inventory systems aren't in sync, it can be impossible to get a clear picture of inventory at any given time, which can lead to a serious breakdown in commu- nication with customers. With an E r P system, delivery drivers are aware of any change in inventory and can communi- cate properly with customers; everyone involved has real-time access to up-to- the-minute inventory data. Products can be loaded, counted, rented and sold from one database. s impler it For your software system to run properly, someone needs to understand it and be able to teach others how to use it. As your business increases and uses multiple soft- ware systems, the support staff needed to train, fix bugs or administer the system itself, needs to increase too. u sing an inte- grated E r P systems requires less supervi- sion, since it is one place providing your overall software services including train- ing, support and new product implementa- tion for the whole company. hme Wayne Bailey is director of client services for Bonafide Management Systems. He can be reached at Is the TPE program really as easy as 1,2,3? How can an ERP system change your DME business? Pro tip: Make sure to develop an open line of communication and establish a rapport with your reviewer What's at stake? Your goal is to pass TPE review in Phase 1 or Phase 2. If you get to Phase 3, you'll need to pay even more particular attention to the denials. Failing Phase 3 will result in a referral to CMS and, likely, a much more expansive audit or extrapolation. W A yne v A n h A lem W A yne b A iley

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