Selected Tag: health care

No Precedent

June 1st, 2010
Web Edition HME Software PECOS Enrollment Check

The speculation on whether PECOS-related edits will deny your claims as of July 6, 2010, is maddening. The most we can say for certain is that it’s a possibility, and could be enforced retroactively.

Scary, huh? Even more frightening is that I can’t think of any business analogy of one party being denied reimbursement for services rendered due to the direct (in)action of another party, whose reimbursement is totally unaffected. Am I missing something here?

Now, on top of that scenario, CMS may allow your reimbursement prescribed by a non-PECOS enrolled provider after July 6. And then, some time this autumn, they can say, “You know what, Mr. HME? We’re a bit short on funds, so we’re going to reverse those claims from July 6 forward.”

Besides unifying behind a strong lobbying force like the AMA, the best you can do is use the best tools available to you to prepare for the worst-case scenario. I believe that includes our Web Edition HME software. Here’s why:

  • you add physicians and their accurate NPIs directly from the NPPES database;
  • you’ll know immediately whether a physician is PECOS-enrolled; and,
  • you’re as efficient as possible, because you never leave Web Edition to get the accurate information you need.

Each PECOS-enrolled physician is highlighted with a green background in the physicians’ smart lookup. Plus, when you select a prescribing physician for an order, you’ll automatically see a "PECOS Enrolled" message display with a green background.

We can’t force physicians to comply with PECOS any more than we can show CMS that dumping on home care actually raises health care costs. However, we could help you get the PECOS enrollment information you need faster. So we did.

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Still Hearing Choruses on Health Care

March 24th, 2010

Let’s offer HME providers (and other business owners) some practical advice. How do you approach your staff regarding this issue?

Communication, as usual, is the key. Jennifer Benz of Benz Communications presents a template for you.

The Kaiser Foundation has a side-by-side comparison tool on its site, so you can select various components of different versions of the bill. The site also features a Health Reform Subsidy calculator that you may want to try.

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“We’re Overregulated”

February 22nd, 2010

I must have been in just the right mood when the PECOS delay was announced last week. That’s what led to last Friday’s post.

You see, I’d just read an article (what was supposed to be leisure reading) in a January issue of The Sporting News. John Feinstein penned an article about college basketball’s dichotomy: graduation rate vs. winning percentage.

In that article, a quote from Duke coach, Mike Krzyzewski, hit me right between the eyes, “We’re overregulated…. Until that changes, things won’t get better.” All of a sudden, that quote transformed my leisure reading into echoing the challenges of HME providers.

“Overregulated.” Obviously, there needs to be some oversight; however, the pendulum has swung so far to the side of punishing innocent HME providers that patients are beginning to feel the pinch.

“Until that changes, things won’t get better.” Not for beneficiaries, not for taxpayers, not for anyone in this health care vertical.

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Still a Major Threat – Part 2

February 17th, 2010

Hopefully, you’ve had an opportunity to read Part 1 of Todd Tyson’s guest post regarding national competitive bidding. Let’s continue with Part 2:

“What does this mean for Medicare beneficiaries? Limited access, no choice, substandard equipment and services. What good can come from low bid providers being awarded contracts with Medicare? Savings sure, but at what cost? Extended hospital stays, patients’ safety concerns, restricted number of providers, elimination of 90% of small business providers.

“HME is the most cost-effective and slowest-growing portion of Medicare spending according to the most recent National Health Expenditures data from CMS. HME accounts for less than 1.5% of the Medicare budget; and, CMS hopes to expand CB to physicians, hospitals and other health care providers in order to cut costs and ration health care to seniors and people with disabilities.

“CB will likely increase spending because it will shift cost from Medicare Part B (Home) to Part A (Hospital). Longer hospital stays and cost shifting from home to the institutional setting will surely follow service disruption and limited access for beneficiaries. Currently under Medicare, a day of oxygen therapy costs less than $7 per day while a day in the hospital costs more than $5500.

“Home care is the most cost effective way to treat most patients; and, home is where most people would rather be. HME is one solution to rising health care costs; but, once again the Federal government has put our Medicare beneficiaries at risk in order to eliminate providers, because they cannot control costs, fraud or abuse in the system. Once again they want to say that providers are the crooks when they [the Feds] are the ones that issued the provider a supplier number and are responsible for policing the behavior.

“There are numerous home care heroes that are out at all hours of the day and night providing in-home services so that patients can live independently in their homes where they prefer to be. These heroes appear at a moment’s notice ready to discharge you from the hospital, follow you home to install equipment, educate/instruct patients and caregivers on proper use, and then leave only to provide 24 hour, 7 day per week on-call services and follow-up to those that need it. Congress is clueless about the services component involved with HME and only reimburses for the equipment. HME is so much more than that and deserves the recognition that HME is the solution and NOT the problem.

“Crook or Caregiver? You be the judge! Call your representatives and ask them to protect HME by sponsoring HR3790 to repeal Medicare Competitive Bidding.”

Thanks to Todd for his contribution. He’s touched on several valid points. Please comment if you have anything to add.

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