Vista Notes is your one-stop resource for timely Medicare updates. Within each issue, DME consultant Andrea Stark utilizes her insight and expertise to decipher how upcoming changes to Medicare compliance, coverage and billing guidelines will impact your business.

With Vista Notes, we do the ground work for you – reporting only on those changes which are truly meaningful to DME suppliers, and interpreting vague or complex regulations into easy to read articles. Andrea Stark's Vista Notes allows you to keep your staff informed without taking time away from other aspects of your business!

Vista Notes is published on a bi-monthly basis, with annual subscribers receiving a total of six convenient issues delivered straight to their inbox per year.

Click here to see a free sample of the current issue!

Read subscriber testimonials here!

By purchasing an annual subscription below, you acknowledge that you have read and agree to MiraVista's terms of service.

Upon subscribing, please look for an e-mail from customerservice(@)miravistallc.com with a download of the most current issue of Vista Notes: February, 2013.

Not ready to commit? Scroll down to purchase a single issue of Vista Notes and see what the publication has to offer!

Whether you are considering if Vista Notes is right for you or prefer to pay on a per issue basis, MiraVista now offers the option to purchase a single issue of Vista Notes. Suppliers who wish to receive a one-time download of only the current issue may purchase a single copy of Vista Notes below.

For your convenience, suppliers who purchase a single issue of Vista Notes will be notified via e-mail of future releases and afforded the option to return to this page to purchase new editions.

Upon completing your purchase, please look for an e-mail from customerserivce(@)miravistallc.com with a download of the most current issue of Vista Notes: February , 2013.

Note: Annual subscribers enjoy a savings of $30 per year over the cost of per issue purchases and receive the latest issue of Vista Notes sent automatically to their email.

Last Updated: August 02, 2012

With Billing Cheat Sheets, you'll always have critical Medicare billing information right at your fingertips! A collaboration between MiraVista and our sister company, ClaraVista, this 37-page document is perfect for those suppliers offering multiple DME who are looking for one, concise billing guide that covers it all.

We reccomend you print the cheat sheets and distribute a copy of the pages that pertain to your business to each AR and billing staff member.

Andrea’s Medicare Billing Cheat Sheets provide a breakdown of the following information for over 29 major Medicare policies:

• Current diagnosis criteria
• CMN criteria
• Important coverage and documentation guidelines (broken down into a few critical sentences)
• Common HCPCS codes and modifiers

Recorded On: May 7, 2013

• An in-depth look at what National Mail Order means to your business
• The effect of the additional cuts from the American Taxpayer Relief Act (ATRA) and Sequestration
• Why your participation status with Medicare matters and how your status determines the options you have for servicing future customers

Recorded On: April 9, 2013

• Ensuring your internal technology policies are effective and enforceable
• Safely sharing and communicating data to your authorized users inside and outside of your office
• Favorite apps and applications for safely storing and accessing sensitive information. 

Recorded On:  April 10, 2013 

CMS just announced that Phase 2 PECOS claim denials will begin on May 1^st, 2013. This new deadline raises many questions for suppliers… How will this impact my revenue? What should I do to get prepared? Are my referral sources enrolled in PECOS?

With the release of this new deadline, MiraVista is offering a timely webinar to get your questions answered and to help providers get prepared. Providers have less than 45 days to get their records updated before the edits are implemented and claim denials begin.

Join us as Reimbursement Consultant, Andrea Stark instructs on the key essentials of the PECOS program and how to avoid unnecessary claim denials. Topics on the agenda include:

• An overview of the PECOS program to date.
• What to expect come May 1.
• Identifying affected claims and referral sources.
• Actionable next steps for providers.
• Resources for educating referral sources.

A live question and answer session with Andrea will take place at the end of the call to ensure your questions are answered. Don’t let your revenue get tied up in unnecessary claim denials, join our webinar today!

• How to make denial management first priority without hiring additional staff
• The essentials of developing and monitoring a strong front-end denial management protocol
• Top tips to effectively handle the denials that are plaguing your company

Recorded On: February 26, 2013

Sponsored by

• The progression of the mastectomy audit.
• Critical components to an audit response.
• Common technical errors that cause denials.
• Putting together a successful audit response.

Recorded On: February 21, 2013

• Oxygen policy changes included in the October 2012 revision
• Oxygen policy changes included in the January 2013 revision
• PAP policy changes included in the January 2013 revision
• Implications to future reimbursement and necessary process changes to reduce provider exposure
• Implications of the face-to-face regulation and specific impact on oxygen and PAP delivery 

Recorded On: February 7, 2013

Digital Recording content from the original air date of December 13th 2012, to include the question and answer session from this event on February 7th 2013.

• Respiratory services - oxygen, RAD, CPAP, vents and nebulizers.
• Glucometers
• Lymphedema pumps
• Manual wheelchairs and accessories
• Hospital beds
• Support surfaces
• Seat Lift Mechanisms
• Traction equipment
• Speech generating devices
• And more…

•  What the rule means to providers of DME
•  Supporting medical necessity
•  Modified elements for written orders
•  New roles for attending physicians and limitations on Physician Assistants, Nurse Practitioners and Clinical Nurse Specialists
•  Separate physician reimbursement for documenting the FTF
•  Applicability to pharmacies
•  

Recorded On: January 28, 2013

• Income tax rates and classification
• New taxes related to the Affordable Care Act
• Changes in allowable business deductions

Recorded On: January 15, 2013

• Technology Crash Course (data security considerations, penalties and HIPAA requirements in the case of a breach)
• Competitive Bidding and MPP Update
• Audit and Reimbursement Outlook
• Best Practices Regarding Patient Collections (and pitfalls to avoid)
• Marketing and Solicitation (avoiding the scrutiny of the auditing contractors)
• Entering the Cash and Internet Sales Marketplace (all that glitters… is not gold)

Recorded: December 13,2012

Co-Hosted by: HME News

• Respiratory services - oxygen, RAD, CPAP, vents and nebulizers.
• Glucometers
• Lymphedema pumps
• Manual wheelchairs and accessories
• Hospital beds
• Support surfaces
• Seat Lift Mechanisms
• Traction equipment
• Speech generating devices
• And more…

• What the rule means to providers of DME
• Supporting medical necessity
• Modified elements for written orders
• New roles for attending physicians and limitations on Physician Assistants, Nurse Practitioners and Clinical Nurse Specialists
• Separate physician reimbursement for documenting the FTF
• Applicability to pharmacies

Recorded: December 4, 2012

Topics to be discussed include:

• Finding and screening potential billing personnel
• Managing and promoting based on value
• Parting with problematic employees
• Managing and maintaining corporate culture
• Managing corporate culture and nuances of management style

We will randomly select attendees to participate in an in depth, round table discussion in January 2013 (included in the original cost/purchase of the webinar). Selected participants will be able to anonymously discuss personnel issues among like-minded peers with the goal of brainstorming and debating possible strategies and solutions.

Recorded: November 27, 2012

• A discussion on recent updates to the oxygen policy that affects what tests you can use to qualify your Medicare patients.
• An update on where do we stand with the new requirements related to the replenishment of non-consumable supplies.
• The latest update on implementing the PECOS edits that will cause our claims to deny,
• A dialogue to understand Market Pricing Program (MPP) the Competitive Bid Alternative, and A discussion of the CMS instruction to replace patient owned equipment without charging for it.

Recorded: August 23, 2012

Medicare has revised its stance on utilizing Advanced Beneficiary Notices (ABNs), specifically when upgrades are provided. Did you know that a device simply being “better,” “higher quality,” or having an “excess feature” may not qualify it as an upgrade? ABNs do not offer protection in every situation, and it’s imperative that suppliers know how to properly execute this tool for the maximum benefit. This recording will provide you with the insight you need to properly complete and execute an ABN in various scenarios. Topics covered include:

• Situations in which you may and may not utilize an ABN.
• Examples of what would and would not constitute an upgrade.
• What auditors expect to see on a properly completed ABN.
• Examples of valid and invalid ABNs.
• Guidelines for estimating the expected cost to the patient.
• Whether voluntary ABNs are truly effective.
• How to execute an unsigned ABN.

Recorded: July 26, 2012

Suppliers were thrown a serious curve ball in the latest of two revisions made to Medicare’s standardized documentation requirements. In addition to the requirement to document the amount of supplies a patient has remaining prior to delivering refills, revised guidance now contains an additional provision designed to prevent suppliers from routinely replacing certain accessories, even if the replacement would be in accordance with Medicare’s usual maximum guidelines.

During this recording, DME consultant Andrea Stark will provide a detailed explanation of Medicare’s latest refill documentation requirements and the impact recent revisions will have on your business. Discussion also covers clarifications regarding: how to document continued use vs. continued need, and what is considered contemporaneous documentation.

Additional topics discussed include:

• New “consumable” and “non-consumable” supply categories, and which products are covered under each.
• Why you may no longer be able to replace accessories based on Medicare’s usual maximum amounts, even if the accessory would normally qualify.
• What auditors will be looking for when reviewing: dispensing/verbal orders, written orders, ABNs, refill documentation and proof of delivery.

The information to be discussed during this event impacts suppliers of all product types.

Recorded: July 12, 2012

A whirlwind of change is taking place in the world of diabetic supplies. In addition to the looming announcement and implementation of national mail-order contracts, Medicare recently made substantial revisions to the Glucose LCD, which were scheduled to go into effect on July 1, 2012. At the very last minute, the DME MACs retracted the revised LCD on June 29, 2012. Although no longer in effect, the changes outlined in the revised LCD will likely resurface in the future. The last minute retraction provides suppliers with an excellent opportunity to gain insight into the current mindset of policy makers and better prepare themselves for the possible implementation of these revisions at a future date.

During this session DME consultant Andrea Stark takes a look at the future of diabetic testing supplies in Medicare. Topics covered include:

• What changed in the retracted LCD?
• Which changes do we still expect to see in future revisions?
• What is the current timeline for the implementation of mail-order contracts?
• What are CMS' plans for retail supplies in terms of Competitive Bidding?
• What are my options if I don’t win or didn’t bid? Can I still hand deliver supplies myself?
• Can I grandfather in my current mail-order patients?

Recorded: June 05, 2012

Ever wonder which documentation you should send in response to a RAC audit? How much do they want? What is the best way to package it together?

Whether you're undergoing a current audit or are just looking for some insight into the RAC auditing process, this recording will provide you with the education you need. Topics covered include:

• How the DME industry may benefit from the Senate Finance Committee's unprecedented request for recommendations to improve program integrity efforts.
• The differences between complex, semi-automated and automated reviews
• Which DME are most prone to review,
• Guidelines for sending in your documentation, and
• Your options for appeal.

Recorded: May 24, 2012

This event is co-hosted by:

Several regulations are in the works that while not necessarily taking center stage will have a significant impact on DME suppliers once implemented. During this recording, DME consultant Andrea Stark takes a look at several of the regulations CMS has waiting in the wings for DME suppliers, including recently implemented changes that you may not even be aware of. Topics covered include:

• A new proposed rule that could leave suppliers facing potential False Claims Act violations for failing to identify an overpayment up to 10-years old.
• Updates to the power mobility device demonstration project, including penalties for failure to obtain a prior authorization and your options if a prior authorization is denied.
• Proposed changes the CMS 1500 Claim Form.
• Clarifications on what constitutes contemporaneous documentation.
• Guidance on documenting continued use vs. continued need.
• Finalized revisions to the supplier standards
• And more!

Don’t be caught off guard! Download this recording and ensure your staff are kept in the loop on important changes that are in the works for DME.

Recorded: May 17, 2012

During this presentationDME consultant Andrea Stark discusses the various scenarios under which a new oxygen rental may begin, and assists suppliers in developing protocols to identify and advise patients of their need to exchange equipment. You will also gain an understanding of your options if the patient refuses new equipment.

In addition, discussion includes a clear explanation of the CMN procedures and documentation requirements for replacing oxygen equipment in each of the following scenarios: reasonable useful lifetime (RUL), damage beyond repair, loss or theft, and qualifying breaks in need.

Recorded: April 24, 2012

Is your business ready for revalidation? With this recording you are sure to be well prepared when the NSC comes knocking at their door. This session will help ensure that you are operating within Medicare’s current supplier standards and will provide answers to your questions on the revalidation process and enrollment in PECOS. 

Discussion  includes:

• A step-by-step guide to enrolling and accessing your data in PECOS
• How to know if you’ve been sent a revalidation request letter
• Paying your application fee
• Getting your storefront ready for inspection
• Questions the inspector may ask
• Documents to have on file
• Current licensure and subcontracting requirements
• Facility size and hours of operation minimums that all suppliers must meet (with limited exceptions)
• Restrictions regarding sharing locations and phone operations
• Anticipated improvements to the PECOS database

Recorded: March 15, 2012

GA, GL, GK, GZ, GY, KX, MS, RR, K0-K4, KH-KJ, K0-KQ, RA, RT, LT.... and the list goes on and on!

Recorded: February 16, 2012

So far we’ve seen two major audits for CPAP sleep test studies implemented by RACs. The most recent of which, is actively occurring in Jurisdiction C (Connolly Healthcare). The number of suppliers receiving these audits is quickly ramping up and the RAC is showing no signs of slowing down. The ongoing audit in Jurisdiction C comes on the heels of a 2011 audit conducted by the Jurisdiction D RAC (HDI), where the contractor improperly denied claims for CPAP patients whose sleep tests weren’t paid for by Medicare. It is critical that suppliers understand the differences between the failed HDI audit and current Connolly Healthcare audit. They are not the same!

Recorded: November 9, 2011

During this recording, Andrea Stark discusses how to appropriately complete and utilize CMNs, ABNs, and supplier generated forms, including:

• Who may fill out which sections of a CMN.
• Your options when information is missing or incomplete on a CMN.
• When a revised, initial and recertification CMN are required (oxygen related).
• Scenarios where you may or may not utilize an ABN for upgrades.
• What to charge when an ABN is on file (assigned vs. non-assigned claims).
• What to do if the patient refuses to sign an ABN.
• Medicare’s take on supplier generated forms.

Recorded: November 1, 2011

This recording will provide DME business owners and managers with the information you need to evaluate the potential impact of Round 2 on your business and to begin making the internal decision of whether to bid on and/or grandfather products. Join DME consultant Andrea Stark as she provides answers to the Who’s? What’s? When’s? Where’s? and How’s? of Competitive Bidding. Topics to be covered include:

• Who is affected (products and MSAs subject to bidding).
• What you need to know if you plan to submit a bid, and your options if you don’t bid or aren’t awarded a contract (grandfathering and subcontracting)
• When bidding is expected to take place, winners be announced, and payment amounts implemented.
• Where traveling patients will need to go to get their DME, once bidding is implemented.
• How CMS determines bid winners.

Recorded: October 18, 2011

It’s the classic catch-22. On one hand, if you request all documentation up front from a physician, you risk becoming burdensome and losing potential referrals. On the other hand, if you request too little documentation, your risk having your claims recouped in the event of an audit. So what are you to do?

Recorded: August 24, 2011

This event generated a substantial number of questions from attendees. Due to time constraints, we were unable to address them all live. As a result, we have perpared a BONUS Q&A transcript of additional frequently asked questions submitted by attendees during the live event. If you purchase a recording, a copy of the transcript will be included as part of your download.
  

This recording is co-sponsored by: HME News

How would you fare if your claims for supplies became subject to an audit?

In today’s audit environment, contractors are turning their attention not just to DME equipment, but to their related supplies and refills. The OIG included the frequent replacement of DME supplies as an area of focus in its 2011 Work Plan, and Recovery Audit Contractors (RACs) have initiated specific reviews for: diabetic testing supplies, nebulizer drugs, CPAP accessories, and enteral and parenteral nutrition.

Providers facing audits for supplies and refills know that proving medical necessity for these items creates its own unique set of challenges. In this recording, DME consultant Andrea Stark helps you audit proof your request for refill documentation and explains what is required to: prove the patient was contacted and refills were authorized, show that supplies are being utilized, and document that refills were delivered.

Specific documentation and coverage requirements are discussed for the following audit-prone supplies:

• Diabetic
• CPAP
• Nebulizer
• Enteral and Parenteral
• Urological

The basics of providing refills for the above product categories is also applicable to suction pumps, surgical supplies, and tracheostomy supplies.

Recorded: July 14, 2011

Effective May 8, 2011, CMS has mandated that for patients with both stationary and portable equipment, the reasonable useful lifetime (RUL) of the portable unit must be synchronized with the RUL of the stationary unit. During this first half of this recording, Andrea Stark discusses the potential pros and cons of the change, and the potential impact on DME suppliers, including:

Recorded: June 7, 2011

In this digital recording, DME consultant Andrea Stark will discuss advanced uses of the ABN, including how suppliers can execute a valid ABN in certain situations where the patient refuses to sign.

• Use of the GA, GK, GL and GZ Modifiers
• Billing for Upgrades
• How Much You Can Collect up Front
• Providing Free Upgrades
• What to Do When an Item is Statutorily Non-Covered
• Executing an ABN When the Patient Refuses to Sign 

Recorded: March 31, 2011

CPAP and Nebulizer claims are constantly under prepay review by the DME MACs. This recording will highlight recent vulnerabilities identified in prior reviews, and help you ensure you have everything you need to submit a successful claim and prevent your payments from being recouped.

• Detailed Written Orders,
• Use of the KX Modifier,
• Documenting compliant use of the PAP,
• What to do when patients are re-evaluated late or do not meet adherence requirements, and
• How to handle patients who have PAPs prior to enrolling in Medicare. 

• What must be included in physician orders,
• Which modifiers to use when billing for drugs,
• How to calculate the correct volume/amount of drugs to bill, and
•  When additional documentation is required. 

Recorded: March 22, 2011

This recording is co-sponsored by:

• Which DMEPOS supplies are most prone to audit and why.
• The top reasons claims are denied.
•  How to avoid common billing errors that could be increasing your odds of being audited.
• Your options if you find yourself caught in the throes of a ZPIC or RAC audit.
• Simple procedures you can implement to protect yourself and your business.
• What to expect from audit contractors in 2011. 

Recorded: March 08, 2011

Insufficient documentation is the number one reason for oxygen claim denials, and oxygen claims consistantly have one of the highest  CERT error rates. Are you prepared to respond to an audit request? During this recording, Andrea Stark helps you understand what documentation audit contractors are looking for, and how to put together a solid response package.

• Maintenance and Service,
• Billing for Contents,
• Delivery, and
• Replacement Equipment. 

• Illegible Physician Signatures,
• Errors on CMNs, and
•  Insufficient Chart Notes.

Recorded on: February 17, 2011

The OIG and DME MACs have recently begun cracking down on payments for DMEPOS supplies requiring the use of the KX modifier. Would your documentation cut the mustard in the event of an audit?

Recorded: February 3, 2011

During medical reviews, diabetic supplies consistently have one of the highest paid claims error rates, with unsupported overutilization being one of the biggest culprits.

Recorded: November 4, 2010

This webinar will help suppliers ensure they have a clear understanding of Medicare’s current coverage criteria for mobility assistive equipment, including manual and power wheelchairs.

In addition to ensuring the patient meets coverage criteria, mobility suppliers will also learn which documents they must have on file in the event of an audit, and how to walk the fine line between “educating” and “leading” the physician.

Topics covered include:

* The 7 Element Order
* Detailed Product Descriptions
* Physician Documentation Requirements
* Use of the KX Modifier
* Which Documents You Must Have on File
* The Use of Supplier Generated Forms

Recorded: September 2, 2010

We’ve all heard stories, we’ve all had questions. We’ve even seen competitors push the envelope – are they wrong or just ambitious? Is it possible we are being too cautious to our own detriment?

This recording will set out to distinguish the difference between Medicare myths and reality. You will learn what is really acceptable under Medicare guidelines as Andrea Stark debunks comming Medicare myths submitted by webinar participants.

Some of the topics covered in this recording include:

• Can we get a valid ABN without a patient signature?
• Does the physician always have to be the one who completes the CMN?
• Can we collect cash from the patient up-front and still accept assignment?
• If Medicare will pay for an item, can I still offer it at a retail only level? What can I charge?
• I've created a form that the physician has filled out and signed. Will it hold up during an audit?
• Can I provide services to a patient in a SNF or home health episode and bill the agency?

Recorded: August 19, 2010

Do you find yourself having trouble collecting from patients? Are you tired of chasing down payments? Your front-end could be the reason patient AR is ballooning. Purchase this recording today, and ensure you’re taking advantage of every opportunity to proactively secure payments and reduce future collection efforts.

During this recording, DME consultant Andrea Stark will help you re-examine your payment policies:

• Are you proactively or reactively pursuing collections?
• Are you taking advantage of collecting payments when you have the most leverage?

She’ll also provide you with several keys to successful patient collections, including:

• Easy to integrate front-end policies and procedures that aid in collection efforts.
• How to determine where to focus collection efforts and when to just let it go.
• How to measure collection momentum and ensure productivity. 

Finally, Andrea will conclude the session by providing you with the tools you need to evaluate a patient’s risk when credit must be extended:

• Is the patient worth the credit risk?
• What other payment options are available?

Recorded: July 15, 2010

“To a man with a hammer, everything looks like a nail.” –Abraham Maslow

What we know is that we need billing talent. If we are unsatisfied with the result, we assume we do not have enough billing talent or the right kind of billing talent. Even the brightest billing staff, however, cannot effectively manage their operation with reimbursement expertise alone. A billing operation without process is like a one-tool toolbox; the hammer is a good tool, but when over utilized, it is ineffective and destructive. If you think you are frustrated, how do you think the hammer feels?

The good news is, you do not need more software, more people, or more complexity. Instead, you need to focus on building a strong billing process. Strong processes address the individually insignificant symptoms before they cause damage, allow the billing staff to use their skills to research and resolve issues that really matter, and allow operational managers and owners to evaluate performance in less than 15 minutes each day.

During this recording, we explore the fundamentals of having a strong billing process as the irreplaceable companion to reimbursement expertise and teach you how to:

• Flush out  process strengths and weaknesses simply...with a piece of paper and a crayon;
• Develop processes that reduce billing errors and the drag on your reimbursement talent;
• Assess performance and return on effort in real time.

This recording is jointly presented by Andrea Stark (the reimbursement talent) and Derrick Stark, CPA, CVA (the opposite) in a point/counter-point format that works through real world scenarios for building process into your billing department.

Simplify your billing operation, improve the results, reduce billing costs, and bridge the divide between billing-speak and the rest of your business.

Recorded: June 25, 2010

Medicare contractors have been instructed to crack-down on the legible physician signature requirement. That means even if you have everything you need to support your claim, it may still be denied upon review if your doctor signed a single CMN, written order or chart note with illegible hand writing (and we both know this happens all the time!).

This recording will teach you how to prepare for potential audits based on illegible physician signatures and the steps you can take now to prevent future denials, including:

• Current Medicare signature requirements;
• What constitutes an acceptable vs. unacceptable signature;
• Guidelines for signature logs and attestation statements;
• What documents must be signed and exceptions to the legible signature rule;
• What is required for Electronic Signatures;
• What happens if a contractor deems a signature illegible and the actions you can take.

Recorded: November 19, 2009

Your AR is the lifeline of your business, but if not properly maintained it will easily grow wildly

out of control. During this webinar, Andrea brings you up to speed on AR tips and techniques to help keep your accounts current and receive faster claim payments.

It’s time to take back control of your AR and gear up for a successful new year! 

• Prescreen Claims to Avoid Denials: Prevent unnecessary denials by knowing what to look for before submitting a claim.
• Benefit from Transmitting Claims Electronically: Sending claims electronically can reduce the burden on your AR department. Learn how to read electronically generated reports for instant insight on the status of your claims.
• Develop Your Own AR Strategy: Effectively work denials, prioritize your AR, and maximize your efforts through better reporting and data analysis.

After listenting to this webinar you’ll have the insight and tools necessary to streamline your claim submission process and decrease turn-around times.

Recorded: July 14, 2009

After listening to this webinar, you'll understand how to use CMNs, know which situations require a CMN and know which CMNs are accepted by Medicare. Andrea provides  step-by-step details on how to properly fill out each section of a CMN, as well as clarifies confusing date and time requirements.

Updated CMN coverage criteria is discussed for the following topics:

• Oxygen (initial & revised CMNs, recertification, testing modalities, etc.)
• Lymphedema Pumps
• Seat Lift Mechanisms
• TENS
• Enteral Nutrition (formulas, pumps, feeding supply kits, etc.)

Learn when to use DIFs, WOPDs, Detailed Orders and more!