A feather in Medicare’s cap for rooting out more fraud. No matter how the publicity angle appears, this is good news for the HME industry.

You’re thinking, “Brian’s finally gone over the edge,” right? Maybe. (Of course, maybe you’d been thinking that for quite some time!)

For at least two reasons, I believe this is positive for legitimate HME providers.

#1 – You didn’t participate in this fraudulent activity, did you? So how can you be held responsible? Don’t fret over what you can’t control. We can’t control whether someone else decides to commit federal crimes.

#2 – Medicare did its job by uncovering these crimes using the current tools available to it. Rather than continuing to tighten the screws on law-abiding, beneficiary-serving HME providers, CMS went after the bad guys. And it worked.

If CMS continues this strategy, other bad guys may decide that bilking Medicare isn’t as profitable as they’d hoped. The result is that more of the Medicare budget will go toward the beneficiaries who deserve a certain level of care.

CMS looks good for its stewardship over our tax dollars. Real HME providers look good for continuing to lawfully provide the products, services and intangibles that you provide every day. Now, that story has potential for a mutual happy ending.

He’s still with us, but barely recognizable as the former player or even the man who most occupied my seat on the row at first base. Ironically, those seats no longer exist after this past winter’s stadium upgrades.

Unfortunately, I don’t believe he’ll get to enjoy the view from our new seats behind the home dugout. I know he’d relish the awesome perspective between the pitcher and catcher.

Now, we just wait. And we remember.

I recall his cheering the home team, accurately calling pitches or hit-and-run plays, and sharing stories of games past. I feel fortunate to have spent this mostly one-on-one time with him over the years.

You see, he was caretaker for my mother-in-law until her passing. We thought he’d get to enjoy the ballpark even more thereafter, but it was as if his health held on just long enough to see her through. Ever since, it’s been one medical issue after another, robbing him of his former independence.

Our family now gets to experience the coordination between hospice and a caring HME provider like you. Thanks, by the way, for all that you do in this respect. Believe me, it’s appreciated.

Meanwhile, rather than in a hospital room, I want to remember him in that seat near the first base coach.

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.

I can just imagine how pleased they must have been with themselves after one presented the idea to create a whole new database of physicians for the sole purpose of verifying their NPIs, which already (supposedly) had been a vetting process to help prevent health care fraud and abuse. My head spins just thinking about it.

When I allow my imagination to delve into these dark places, I can picture them high-fiving each other as their meeting adjourns. “Another victory for the American taxpayer.”

Of course, they delegate other minions (paid for by us) to administer PECOS, yet another government health care directive and its details. If it weren’t so absurd, it’d be laughable.

How bad is this idea? If PECOS was so wonderful, why has Phase 2 implementation been delayed a second time — this time for nearly a full year? Just counting all the ways is depressing.

Let’s start with putting the onus on the providers that can’t get reimbursed without action by other providers who have no incentive to comply because their reimbursement isn’t affected. I wonder who came up with that one.

Then there’s the eventual unveiling of the great and wonderful PECOS database — as a PDF! Obviously, some government employees had been tasked to create the database. But then they were tasked to convert it to a nearly useless format so companies like ours would need to spend time to reverse the process in order to properly help our clients.

When testing our version of the PECOS database against client data, we discovered that approximately 50% of physicians had enrolled. So, the same people you need to bother for ever more medical necessity documentation now also must enroll in PECOS for the same reason: so you, the HME provider, can get paid for products and services rendered.

Anyone have aspirin? My head hurts, and another brilliant government idea called NCB is still barreling toward us at breakneck speed.

A well-respected HME provider and ten-year CAU client, Todd Tyson, recently authored his thoughts regarding the recurring NCB nightmare and what you can do about it. Here’s Part 1:

“Atlanta will soon begin the bidding process for the second round of Competitive Bidding (CB) for Medicare Home Medical Equipment (HME) slated to begin in Atlanta in 2011. CB was part of the Medicare Modernization Act (MMA) of 2003 that most of us recognize as the prescription drug bill which mandates that Medicare bid for home medical equipment and services. CB was originally supposed to begin in 10 Metropolitan Service Area (MSAs) in 2009 and expand to 80 more in 2010 including Atlanta however the program was so fatally flawed that Congress passed the Medicare Improvement for Patients and Providers Act (MIPPA) to postpone the implementation until 2010 so that the Centers for Medicare and Medicaid Services (CMS) could fix the problems inherent in the MMA.

“Sadly CMS has decided to move forward again with CB in 9 MSAs without any real improvement to the initial plan or process. The first round of bidding awarded contracts to providers that were not appropriately qualified or licensed to satisfy the regulatory requirements established by CMS supplier standards. Many winning bidders had never provided the services that they bid for and were awarded. Most did not have the credit necessary to fund the business and the growth required to satisfy the capacity that they were legally obligated to provide. One manufacturer was even quoted as saying that of the 380 winning bidders he would not extend credit to, more than 50% and several of the other 50% were already on credit hold.

“The original bid process was to yield a 27% saving to Medicare HME only because non-qualified underfunded bidders bid way below Medicare allowed fees. Some local providers bid low for fear that they would be barred from participation and other non-local providers bid even lower in order to eliminate local providers and gain new markets. No one truly understands why providers were willing to low ball bids, but the reality of the contracts was unsustainable for most bid winners.

“What does this mean for Medicare beneficiaries?” We’ll find out next time as we continue with Todd’s guest post. Meanwhile, you’re welcome to add your opinion to the conversation.

Last time, we discussed the importance of up-to-date documentation for your HME software. I believe that it should be part of the service to you, the HME provider.

Think of it this way: if there isn’t any documentation available to you, the customer, where does your HME software vendor’s customer service team turn to support their answers? The sheer complexity of third-party DME billing deserves some point of reference.

What reference materials should you expect in addition to up-to-date, dynamic documentation? Every field label in our Web Edition HME software is a link to a specific definition. With a click, you can view the definition in a small window while your Web page remains active.

Additional links open pages on other Web sites so you can easily reference payer requirements, confirm physician NPI data, and verify patient eligibility.

We also understand that different users retain information differently. Some learn through reading step-by-step instructions; others may prefer an audio-video presentation.

So we added online instructional videos with narration to the various topics throughout Web Edition. This is an idea that we adopted from our server-based CBT series.

Speaking of our server-based HME software, I mentioned last time that the current delivery method of documentation is PDF accessed by a click from the software. I should acknowledge that it isn’t just a 900-page hodge-podge of information.

Our current documentation specialist created a Table of Contents, an index, as well as standard PDF bookmarks, so you can zero in on any available topic. You can also use the handy PDF “Find” feature to locate a specific word or phrase.

True documentation takes you field by field through a given procedure, but what about the overall process? Our online knowledge base is very popular with our users. Think of it as a collection of “How To” articles on our Customer Resources Web site. You can even search by keywords to find the article you want.

Although this very detailed work doesn’t directly generate revenue for HME software vendors, we believe that fresh documentation is a valuable asset to our users. It’s the next best thing to personalized training.

That’s what we’ll discuss next time.

Meanwhile, what’s your favorite aspect of your HME software vendor’s documentation? How about your least favorite?

As an HME provider, you understand the importance of documentation. If you don’t document properly (as defined by the payer), you don’t get reimbursed for your work.

Today, we’ll discuss HME software documentation. I’m still surprised when I ask providers about their HME software documentation and they respond with a chuckle, “What documentation?”

How can any company develop software for this vertical without providing proper instructions on how it’s supposed to work for the user? I understand that it’s a huge project, but shouldn’t that be part of the service to the HME provider?

When I arrived at CAU in January, 2000, we had a full-time technical writer whom I was to direct. This person was very detail-oriented and amazingly remained up-to-date with documentation of any enhancements to the software.

At the time, this wasn’t an easy task. Especially considering that printed pages (all 900 of them) in three-ring binders was the only delivery method available. The challenge was that as soon as the pages were printed, some were outdated. But she persevered.

Later that year we began to save documentation as PDF, which were available within our server-based HME software (and still are today). Another professional technical writer took the reins five years ago this month and does an incredible job of keeping pace with both our server-based and Web-based documentation (in addition to other tasks).

CAU’s Web-based documentation displays online in a wiki format. If you’re familiar with Wikipedia, you’ll recognize the links at the top , the search box to the left, and the full content below the links.

This is as fluid as documentation can get, because we can update any page instantly for all users. Internal programming documentation allows us to catch every software update. Nothing falls through the cracks. And the users love it!

They can work in one Internet browser tab side-by-side with the documentation on the next tab. They can easily toggle back and forth until the task is complete. The wiki pages change dynamically as users move from page to page in the software.

This is what I’d always envisioned to help our user base with practical content; however, HME software documentation can, and should, go even farther for you. That’s what we’ll discuss next time.