Most payers, from commercial to Medicaid to Medicare, offer providers web based, portal access at no charge. But in our experience, provider portals are widely underutilized tools across the supplier community. People are generally comforted by speaking to a live human to get answers. But, technology can provide us with more consistent answers at a fraction of the time. And while there are occasions where you will have to speak with a representative, picking up a phone should not be the go-to option. We cannot afford to waste 10 minutes to an hour for information that could be secured in under a minute via a portal. Signing up for provider portals can be much easier (and faster) than you think. Most importantly, having access can enable your staff to check claim status, eligibility, prior authorization status and even secure remittance information without picking up a phone, dealing with an IVR, or wasting valuable research time listening to on-hold music. Adding portal access is a MUST for efficient operations.
On May 5th, after rescinding prior publications, the DME MACs issued a revised joint publication to address coverage and coding guidelines for ventilators. At first glance there were no material changes, but the language is notably softer on several key statements regarding coverage. This is one of many signs that CMS is listening to the industry and clinical organizations that are seeking more intuitive ventilator coverage interpretations.
Since issuing a 2001 decision memo, CMS has educated that ventilators are decidedly distinct from Respiratory Assist Devices (RAD). The memo’s backdrop compared RAD for Chronic Obstructive Pulmonary Disease (COPD) to invasive ventilation administered through an intubated airway. It further established that ventilators should be utilized when “failure of respiratory support leads to death”. These seven words severely limit the application of ventilator coverage and have guided MAC ventilator coverage decisions since the issuance of the memo.
Hiring is really hard. That is why it is every manager’s least favorite job. We at MiraVista have discovered, after our share of painful missteps, that who and where we recruit are critical to building the right team. The answers to those questions, however, are seldom obvious.
After 13 years of perpetual experimentation, our current staff is made up of talent we found from a variety of sources: the physical sciences, hospitality management, and public school administration. We even have a former mortician. In fact, we do not actively seek out people with medical billing experience. We find that hiring based on character traits such as critical thinking, problem solving, and customer service yields very strong results because those individuals bring applicable experience from outside our spheres of comfort and experience. We can teach the technical aspects of medical billing and produce experience in our field, but we cannot fabricate the passion or depth that helps us mature and advance as our industry changes.
In a revised joint publication issued by the MACs last week, CMS clarified their position on what is required to deliver equipment under the Affordable Care Act (ACA) Face-To-Face (FTF) Rule. Since the beginning, the MACs have educated that a fully compliant detailed written order (DWO) with an NPI and date stamp was required to DELIVER any product subject to FTF. The final rule, published in November of 2012, clearly outlined a minimal 5 element order for HCPCS subject to the FTF rule, but the MACs (and CMS) implicitly directed suppliers that a full DWO was required. With this recent clarification, however, it is now CMS’s intent that the MACs require suppliers to secure a minimum, five element order (5EO) prior to dispensing items addressed in the FTF/ACA rule. The simplified, 5EO must include:
The 5EO must be date stamped to document the receipt date by the supplier prior to delivery. Still, prior to BILLING suppliers must continue to secure a fully detailed written order to be in compliance.