Our consulting firm frequently gets questions from companies about how to move forward when patients experience interruptions in service. Suppliers routinely perform same and similar queries and find orphaned rental payments posted on prior CMNs with Medicare. This scenario often promotes uncertainty with the staff as to how to proceed with a new setup… will we get paid a full rental or will we have to eat those residual payments? While there are many variations as to why this happens, we will explore the most common scenario that impacts CPAP patients: non-compliance.
By Derrick B. Stark, CPA
Over the last year or so, we have observed a growing number of providers successfully increasing overall average collection rates by more than 10%, and routinely exceeding 95%, by implementing effective autopay or credit card on file programs. Most impressive of all, they are doing so with less staff time and opportunity cost than required previously to get lesser results.
The point of this article, however, is not to itemize a plan for implementing such a process; we will do that later. Instead, we first want to talk about the prerequisite obstacle that, without its defeat, there is no chance for success with even the most well-crafted policy.
The “all or nothing” paradox.
It's hard to believe but, as we near the end of October, we are fast approaching the New Year. Your customers are already receiving advertisements from various health plans encouraging a switch to newer and "better" plans. Many will end up switching without considering existing relationships and active rentals with their suppliers. It just doesn’t occur to them.
Inevitably, denials are going to appear on your January and February EOBs. You know it’s coming... patients switch to plans where you are not in network, or where the new plan requires authorization, new documentation, new office visits and the like. But, what if you could prevent these denials, would you? Not only can you, many have already done this successfully. Yet still too few have changed their processes.
When using the ABN form, it’s important to execute the form with confidence as to why (or if) it is needed. As a general rule, ABNs should not be executed when you expect a claim to pay (upgrades and a few exceptions included). When ABNs are appropriate, suppliers have been instructed to indicate to Medicare whether the ABN is required or voluntary. So, how do you know if an ABN is required or voluntary?
A required ABN is issued under the following circumstances: