Andrea Stark gives DME suppliers tips on how to make the most of every dollar they receive and reduce outstanding AR.

“We have to do more with less. AR efficiency has to be a top priority.”

 

Interview courtesy of HME News, Executive Editor Mike Moran. 

Can’t see this video? Click here to watch it on HME News TV.

On January 14th the Office of Inspector General (OIG) issued a Special Fraud Alert (SFA) in response to reports of DME companies cold-calling Medicare patients. Unsolicited direct and third party DME telemarketing calls are a violation of section 1834(a)(17)(A) of the Social Security Act, which only allows suppliers to contact patients if: 1) they have received prior written consent from the patient, 2) are calling about a previously supplied item or 3) have furnished an item to the patient within the past 15-months.

 

The problem for DME suppliers arose when the OIG’s alert classified first-time calls to patients for which a physician order had been received as ‘cold-calls,’ stating that “a physician’s preliminary written or verbal order is not a substitute for the requisite written consent of a Medicare beneficiary.” This created a dilemma for suppliers who were now left wondering whether they could continue contacting new patients to arrange for delivery.

 

Upon release of the alert, several industry stakeholders wrote letters to both the OIG and CMS expressing their concerns over the OIG’s interpretation of what constitutes cold-calling.

 

In response, the OIG issued a recent letter stating that its SFA’s are meant to provide suppliers with guidance on what constitutes fraudulent practices, and that the recent telemarketing SFA “does not articulate a new interpretation of the law.”

 

In conjunction with the OIG’s statement, CMS also released a six question Telemarketing FAQ for DME suppliers. Per the FAQ, suppliers may contact a patient based on the receipt of a physician order, IF the patient has been made aware that a supplier will be contacting them regarding the prescribed DME. In this case, the patient’s physician may contact a supplier on behalf of the patient, who may in-turn call the patient to confirm delivery and billing information. The key point here, is that the patient must understand that their physician will contact a DME supplier on their behalf. If a supplier calls a patient based solely on a physician order and the patient had no knowledge that their physician would even contact a supplier, the call would be  considered unsolicited.

 

Also of note, is that suppliers may only use the initial call to discuss those items in the physician order and may not solicit sales for other DME. 

 

CMS has left the decision of whether to collect and maintain documentation from the physician showing that the patient is aware they will be contacted to the supplier’s discretion.

On an Open Door Forum call held at 2:00pm EST today, CMS announced that they will be delaying implementation of the PECOS edits until January 3, 2011. This buys additional time for DME suppliers who were scrambling to get physicians enrolled by the previous April 5^th deadline.

 

An update to change requests 6417 and 6421 is expected to be released in the near future. In the meantime, suppliers will continue to receive warning messages on their GenResponse reports and should continue their efforts to get physicians enrolled. Remember, this is not the death of PECOS, only a delay.

 

To assist providers in their quest to get physicians enrolled in PECOS, the Part B MACs will be sending revalidation letters to all physicians who have not updated their Medicare enrollment in over 6 years. (Medicare contractors first began updating the PECOS database with physician enrollments in November of 2003; therefore, physicians enrolled prior to this date will not be in the database.) Physicians enrolled in Medicare for more than six years who have made no updates to their status will receive a request for revalidation from their MAC. The letter will instruct the physician to submit either an updated paper enrollment form or to enroll online via PECOS.

 

According to CMS, DME suppliers will also be given access to PECOS later this year. That means suppliers will soon have the option of enrolling in Medicare or updating their information online.

 

On a final note, suppliers should be aware that Medicare contractors are currently conducting an increased number of on-site reviews. While CMS did not give specific reasons for the reviews, they did say that contractors are in the process of performing heavy licensure and accreditation checks. If you need to make a change to your state licensure or accreditation status, you should notify your contractor as soon as possible.

While doing a bit of research on the latest developments with PECOS, I came across a website that I just had to share. It belongs to a company by the name of Physician Filing Services, Inc. (PFS) and offers DME suppliers a fast and free way to search the 13-some-odd-thousand pages of CMS’ PECOS list.

 

The company, which appears to perform medical billing services for physicians, medical practice groups and skilled nursing facilities, has reformatted the less than user friendly PECOS .pdf into a searchable SQL database. While PSF certainly wasn’t the first or only company to crack the .pdf file, they did think the process through and offer suppliers an added value. When developing their search tool, PSF took the PECOS list and cross-referenced it directly with the NPPES database. By cross referencing with NPPES, PSF allows suppliers using their NPI/PECOS Validation tool to lookup physicians via a variety of fields, including: provider name (a min. of 2 letters are required), city, state, NPI and/or alternate ID (i.e. UPIN, Medicaid). Broad searches, such as “John Smith” will result in a large number of returns. However, by using a more detailed search, suppliers may narrow their results down to a specific physician.

 

Because the validation tool is directly linked to NPPES, it’s important to note that just because a physician is found initially, does not mean they are in PECOS. The initial search for a physician only validates that the physician is in NPPES, which is NOT an indicator of whether or not they are Medicare participating or PECOS enrolled. After performing a search, suppliers must click on the physician’s name to see if they are registered in PECOS. The tool will then display the physician’s information, as reported in NPPES, and indicate whether or not the NPI for that physician was found in the PECOS list.

 

Another great feature of the PSF search tool is that the contact information for every physician is displayed for suppliers from the get-go, eliminating the additional step of going to the NPPES website to search for it. This makes it very easy for suppliers to begin education initiatives for physicians identified as not enrolled in the PECOS system.

 

If you’d like to try this tool out for yourself, you may begin searching for your physicians by visiting: https://pfspays.askhmg.com/PECOS/npi.asp. Remember, once you find your physician, you must click on their name to see if they are registered in PECOS.

 

While I am happy to share this find with you, please keep in mind that MiraVista is not associated with PSF in any way and therefore cannot vouch that their validation tool will perform without error. The tool is currently using the PECOS list uploaded by CMS on January 28, 2010. This list will be updated on a monthly basis, and I would expect PSF to keep their search tool current and updated with each release. However, I cannot make any guarantees on their behalf.

Suppliers now have a way to compare their referral sources against a list of those registered in the PECOS database!

 

With the issuance of CR6421, CMS promised to provide DME suppliers with a searchable database of PECOS enrolled physician and non-physician practitioners prior to the implementation of rejections on April 5, 2010. On January 28, 2010 CMS made good on their promise in the form of a 13,653 page .pdf (Adobe Acrobat) file, containing the NPIs, first and last names of all Medicare eligible referral sources currently enrolled in PECOS. The file is 16.63 MB in size and includes approximately 800,000 physician and non-physician practitioner records sorted by last name.

 

DME suppliers may download the file here:

http://www.cms.hhs.gov/MedicareProviderSupEnroll/Downloads/OrderingReferringReport.pdf.

Due to the size of the file, download times may range anywhere from 42 seconds to 42+ minutes, depending on the speed of your internet connection. For us, it took approximately 1.5 minutes. Once your download is complete, be sure to save the file to a specific location on your computer, so you don’t have to re-download later.

 

The good news, is that suppliers who download the file will now have a way to verify whether or not their ordering physicians are enrolled in PECOS. Using the search (Ctrl+F) feature, suppliers may look-up the NPIs of referring physicians and verify the correct spelling of their first and last names, as listed in the PECOS database. The bad news, is that since the file is in a .pdf format, there is no easy way to narrow down, filter, or otherwise sort through the nearly 800,000 records.

 

Suppliers should keep in mind that the list is a work in progress and will be updated/replaced on a monthly basis. Also, because of the time it takes contractors to review a physician’s PECOS enrollment application (typically 45-60 days), newly enrolling physicians may not be included in the searchable list until two or even three months after they submit their application.

Just last week the Office of Inspector General (OIG) issued a Special Fraud Alert in response to reports of DME companies cold-calling Medicare patients. Direct and third party DME telemarketing calls are a violation of section 1834(a)(17)(A) of the Social Security Act, which prohibits suppliers from calling Medicare patients unless one of the following conditions are met: 

 

1. The patient has given written consent to make contact by phone.
2. The contact is regarding a covered item previously supplied to the patient.
3. The supplier has furnished at least one covered item to the patient within the past 15 months. 

 

In the alert, the OIG interprets this section of the Act to include all first time calls to patients, even if a written or verbal physician order has been received, stating that “a physician’s preliminary written or verbal order is not a substitute for the requisite written consent of a Medicare beneficiary.” This presents a real problem for suppliers who are now prohibited by this update from making calls to new patients to arrange for delivery.

 

While the clear intent of section 1834(a)(17)(A) is to protect elderly patients from being bullied into purchasing DME over the phone,  Jeff Baird, a healthcare attorney with Brown & Fortunato in Amarillo, Texas, says the OIG’s interpretation of it is both overreaching and illogical.

 

“It is a matter of convenience for the patient for the supplier, upon receipt of the physician’s order, to call the patient and arrange for delivery,” said Baird. “This scenario comes nowhere close to the “unsolicited telemarketing” concerns raised by the OIG in the updated alert.”

 

Several industry advocates have already begun drafting response letters to send to the OIG.

Finally! There’s good news for providers worried about the number of PECOS warning messages on their GenResponse Reports. In a statement released today, CMS announced that they have completed a systematic update of the PECOS system, in which NPIs have been added to the enrollment records of all physicians / non-physician practitioners.

 

Many physicians were added to PECOS prior to May 2008, when the NPI became a mandatory identifier. Because the new claim edits look for a physician’s NPI first, these incomplete records have been firing warning messages identical to the problem physicians who had no PECOS record at all. Until now, providers had no way of telling whether a flagged physician just needed to update their information or go through the entire PECOS enrollment process, based on the warnings alone.

 

Now that the NPI update is complete, suppliers should see a definite decrease in the number of C200, C201 and C202 warning messages on their GenReports. However, this does not negate the need for action. Unless there is an uncorrected spelling or NPI error in your billing software, these physicians must be educated on the PECOS edits and complete enrollment prior to April 5, 2010, or your claims will result in rejections.

 

CMS has also promised to release an internet-based tool that will allow providers to scrub a physician’s NPI against those listed in the PECOS database. The tool will be made available prior to the start of rejections (currently scheduled for April 5, 2010); however no specific release date has been provided.

By: Derrick Stark, CPA, CVA - ClaraVista LLC

 

Andrea buzzed me on the intercom a few weeks ago and said one of our clients needed a schedule of active CPAP patients by zip code with the estimated cap date. Not only did they need it that morning… they needed it within the next 30-minutes. I told her I’d see what I could do and got to work.

 

Long story short, we sent the client a schedule, they had a wildly productive meeting, and everybody was happy.  Although the timeline was a little tight, we pull these kinds of “on-the-fly” analyses together all the time in our business. How do we do it? We use a tool that you probably have on your computer right now, Microsoft Excel.

 

As someone working in the reimbursement sector of the DME industry, I’ve found that providers often have helpful tools at their disposal that no one has taken the time to really teach them how to use. Case in point, Excel.

 

You may be reading this right now, thinking, “I know how to use Excel. I use it all the time.” But if you’re only using the program to produce financial statements or budgets, you’re just barely scratching the SURFACE of what it can do! In fact, this week alone we’ve used Excel to:

• Match physician address and telephone information from our billing software to our list of PECOS warnings to create a complete call list for physician education.
• Prioritize our call list relative to the patient volume associated with each physician resulting in a warning message.
• Identify claim concentrations by HCPCS code and payor. 

And the best part is, it doesn’t take an accountant or technical expert to use Excel. In fact, with a little practice, the receptionist or delivery tech might be your best data analysts.

 

If providing your staff with the tools to work smarter, not harder is something that interests you, then I invite you to attend my live webinar tutorial entitled: Using Excel to Maximize Efficiencies in Your AR Department on January 21, 2010. Using sample reports relevant to the DME industry, I will show you how to use Excel to strategically analyze, sort and format data, providing you with knowledge that can be readily applied to your own sales, collections and AR reports.

 

The course is broken down into two classes, one for Excel 2003 users and one for Excel 2007 users.  We will skip “How to Minimize a Window”, the “CD-ROM or cup holder debate”, and other uber-basic matters of PC use, but advanced Excel knowledge or experience will definitely not be a requirement.  Attendance is just $49. For more information or to register, click here or visit www.miravistallc.com/recent_services.php.

DME suppliers who did not meet surety bond or accreditation deadlines were advised to voluntarily terminate their billing numbers to prevent being suspended from the Medicare program for a period of one year. Those suppliers who submitted a voluntary termination request did so with the understanding that billing privileges would be reinstated once they met all Medicare billing requirements and billing would be retroactive to the date of accreditation.

 

However, CMS recently threw a serious monkey wrench into the mix when they stated that suppliers would NOT in fact be able to bill retroactive to their date of accreditation, as previously thought. Instead, suppliers must now wait until their CMS-855S applications have been processed by the NSC to begin billing Medicare and will only be able to bill for services performed on or after the date their number is reactivated.

 

Several organizations, including AAHomecare, MAMES and the NSCAC are working towards a reversal of this policy. You can count on MiraVista to keep you posted on any changes.

H.R. 3790, a bill to eliminate the Competitive Bidding program now has 118 co-sponsors.

 

H.R. 3790 was introduced by Rep. Meek (D-FL) on October 13, 2009 and has been dubbed the Meek Bill. If passed, the bill would effectively repeal the Competitive Bidding program and terminate the contracts of any bid winners.

 

To keep itself budget neutral, H.R. 3790 proposes two separate cuts in the consumer price index. The first cut of -0.25% would affect all DME except for Group 3 complex wheelchairs from 2010-2012. A second cut of -0.5% would then occur in 2015 (Group 3 wheelchairs would again be exempt).

 

Updates on this bill, as well as the Competitive Bidding program will be covered in Andrea Stark’s next issue of Vista Notes.