Issue link: https://read.dmtmag.com/i/36987
6 News BY ELIZABETH DEPREY, Associate Editor YARMOUTH, Maine – The majority of HME providers not only keep track of their denial rates, they’re work- ing hard to reduce them. According to a recent HME News Poll, 79% of providers track their denial rates. They’re trying to keep those rates in check by, among other things, educating everyone from their employees to referral sources to patients. “We are asking our patients to play a part in the process by hav- HME NEWS Ariz.-based AireCore Medical Services. Other strategies: Performing eligibility checks prior to deliver- ing products and wait- ing until claims are WWW.HMENEWS.COM / AUGUST 2011 / HME NEWS Providers use education to ward off denials POLL ing them take notes to the MD that prompt them to document correct- ly,” said Cliff Doss of Fort Smith, complete before filing. Despite their efforts, for 44% and 36% of providers, denial rates have stayed the same or increased in the past year. That’s left some providers feeling discouraged. “CMS has made it very difficult to comply with all of the documen- tation requirements,” said David Warren, owner of Matthews, N.C.- based First Choice Medical. “No matter how hard you try, they can (and do) find something wrong OIG CONTINUED FROM PAGE 4 services for non-Medicare and Medicare patients. The OIG takes issue with both arrangements. First, it believes they have the potential to cre- ate payment based on volume or value of past or expected refer- rals (the first arrangement) or payment above fair market value (the second arrangement). Second, the OIG believes the arrangements may trigger the anti-kickback statute because the sleep lab’s staff is in a posi- tion to influence patients to select the provider’s products, regardless of whether it gives them a list of other providers to choose from. “The fraud and abuse risks are compounded where a physician or other healthcare profession- al is involved in the marketing activity—a practice sometimes referred to as ‘white coat’ market- ing,” the OIG states. “White coat marketing is closely scrutinized under the statute because physi- cians and other healthcare pro- fessionals are in an exceptional position of public trust and thus may exert undue influence when recommending healthcare relat- ed items or services.” The OIG believes it doesn’t matter whether the arrangement involves non-Medicare or Medi- care patients, because one busi- ness can influence the other. “The idea that deals for private patients supposedly don’t raise federal issues because they don’t involve federal patients is a fre- quent misconception,” said Neil Caesar, president of the Greenville, S.C.-based Health Law Center. The OIG’s conclusion was predictable, leaving at least one industry attorney to question the motives of the provider who requested the opinion. “The requestor in this case may have been seeking a negative opinion in the hope of dissuading its competitors from participat- ing in arrangements like these,” said Jeffrey Baird, chairman of the Health Care Group at Ama- rillo, Texas-based Brown & For- tunato. “It appears that the OIG was happy to oblige. The agency went further and used the occa- sion to deliver a harangue against ‘aggressive marketing by DME suppliers.’” HME with your claim.” High denial rates have led Affili- ated Medical Equipment to stop providing CPAP machines to Medicare patients altogether, said Ed Wimbish, president of the For- estville, Md.-based company. Among the 73 respondents who took the NewsPoll, oxygen was the top culprit for denials. HME