Issue link: https://read.dmtmag.com/i/52926
HME NEWS / FEBRUARY 2012 / WWW.HMENEWS.COM How big is your vocabulary? BY LEN SERAFINO T HE HME industry is beset by challenges beyond anything imagined just 10 years ago. From the implications of ACOs to competitive bidding to ZPICs, industry stakeholders, regardless of their views, must take steps to either defend or challenge these changes. In short, effective communicators are needed. Are you ready to speak your mind? Many of us have strong beliefs about what we see happening to our businesses and its impact on patients and caregivers. However, expressing our beliefs and concerns isn't always easy. Some can readily commu- nicate with confidence; others, not so much. Having accurate information is critical to ensuring positive out- comes, but information that isn't clearly expressed is often lost in the maelstrom. Your communication skills can make the difference between success and failure when you are trying to tell your story, whether it's to a patient, an employee or your member of Congress. Whether communication is a weakness or strength, we can all make improvements. The size of the average person's vocabulary has been much debated. But there is a well-established correla- tion between a strong vocabulary and success. Accord- ing to the Johnson O'Connor Research Foundation, only about 3,500 words separate the high vocabulary person from the low. Yet those 3,500 words can make the difference between success and failure. Time and again research has shown that a bigger vocabulary is linked to more sales, better jobs and more money. Here are three things you can Len Serafino do to grow your vocabulary: 4 When you come across words you don't know, write them down and look them up as soon as you can. It will increase your conscious awareness of words and their uses if you make a special effort to notice these words, learn them and use them. Repetition is the key. 4 Pick up a vocabulary book or CD like Verbal Advantage by Charles Harrington Elster. Make it a practice to review five words a day. You can also sign up with Merriam Webster to get a daily email with the word of the day. I know: You're very busy managing your business. Taking the time to look up words or read vocabulary books, while worthwhile, adds to your already heavy work load. Too much? Let's try the third tip: 4 Read more: Reading will help you add to your vocabulary. In fact, reading might be the best way to improve your vocabulary. Studies show that a 5th grader reading six minutes a day is exposed to about 430,000 words a year. If that same child read for 60 minutes a day he or she would Commentary 3,500 words make a difference If you want to be an effective advocate for your business and our industry, pick up a book and keep a dictionary handy read 4.3 million words a year. This is important because other studies have shown that people learn consider- ably more words by reading as opposed to hearing new words. How many times do you come across a word while reading that you can't define, yet you understand it in the context of the sentence or paragraph? You really can grow your vocabulary just by reading more. People judge you by the words you use. Every time you speak to someone, they are trying to figure out how competent, successful and smart you are. Research has shown that people are more likely to be judged as competent and smart when they speak with a good vocabulary. If you want to be an effective advocate of your business and our industry, grow your vocabulary. When you need to make a critical point, having the exact word at your command is powerful. In our industry, many of us are being called on to present our views in public forums, including congres- sional hearings. Making a presentation, whether it's to an audience of 10 or 1,000, is a skill. It's been repeated many times that fear of public speaking ranks higher than the fear of death. Maybe so, but chances are, if you're reading this, you are either in a leadership posi- tion or headed in that direction. It is highly probable that you will have to present your views or expertise to your co-workers, a board of directors or civic group. You could find yourself in a situation where our entire industry is counting on you. Regular practice is the best way to improve your pre- sentation skills. One way to get the practice you need is to join a Toastmasters International group. Many well-known people from various fields, including Chris Matthews, have improved their skills through Toastmasters. Our industry is experiencing profound changes and facing daunting challenges. We don't have the luxury of merely hoping that our industry's top lead- ers alone can carry the burden and win the day. They need everyone's help. We need to keep leaders abreast of what's happening on the ground, clearly communicating what we see and what we believe. Each one of us must take responsibility for clearly communicating our patients' stories and what we are doing to improve their health and well-being. If we want to have a meaningful, positive impact on the payers and regulators that are making decisions about our future, we have to be effective communi- cators. In short, we have to be outspoken advocates for our patients, employees and the industry. We can only do well in the long run if we make it plain that we are also doing good. HME Len Serafino is a regional vice president, respiratory sales, at Drive Medical. He is also the author of Sales Talk, a book on the role communication skills play in achieving sales success. His background includes many years as a member of Toastmasters International. Prepare and respond AUDITS: PART 2 BY JEFFREY BAIRD W Editor's note: This is Part II of a five part series. Part III will address post- payment audits; Part IV will compare post-payment audits and prepayment reviews conducted by DME MACs with those conducted by ZPICs; and Part V will discuss contractor abuses. HAT IS a prepayment review? With a post-payment audit, the provider has previously received payment from the MAC, and the Medicare contrac- Users will tell you TENS works I THE MOST important element needed in your story is that CMS has never even tried to contact users at home ("Trouble for TENS?" HME News, November 2011). All they would have to do is look at their database and see who is currently receiving electrodes to use TENS and ask them—period. They would not need to have to review any articles. I guess that might not fit their study data and that would be too easy. The administration needs to get money out of Medicare to fund the Affordable Care Act, which is destroying the economy. —Byrle Darland, president/owner, dMedicus, Rockwall, Texas tor is trying to determine if the MAC should have previously paid the claim. If the answer is "no," then the contractor will ask the provider to repay the money. While a post-payment audit is unpleasant, it is not "life threatening." A prepayment review is more serious in the sense that the contractor will not initially pay the claim until the provider submits documentation confirming to the contractor that underlying documen- tation is proper. Only MACs and ZPICs conduct prepayment reviews. If a claim is denied at the prepayment review stage, and the provider goes through the appeal process and eventually ends up before an ALJ, then it may take the provider up to nine months to receive payment. WHAT CAN TRIGGER A PREPAYMENT REVIEW? One factor is if the provider furnishes items that are selected by the OIG for prepayment edits. Another factor is if the provider has caught the attention of the MAC or ZPIC. This may result from (i) the provider faring poorly with prior post- payment audits and prepayment reviews; (ii) data analysis indicating that the provider sub- mits claims that are "outside the norm;" and (iii) complaints from physicians and benefi- ciaries. To reduce risk, it is important that the provider be successful in responding to prior post-payment audits and prepayment reviews. It is important that the provider have a good relationship with physicians and beneficiaries so as to reduce the chances of a complaint being filed. HOW IS A PREPAYMENT REVIEW CONDUCTED? The provider will submit a claim to the MAC for a product that the provider has furnished to a beneficiary. Instead of paying the claim, the MAC/ZPIC will mail an additional document request (ADR) to the provider. The provider will need to send the requested documentation to the contractor within 30 days. If the prepayment review falls under the category of "Medical Review," then the con- tractor must reach a determination within 60 days from receipt of the provider's documentation. Normally, it is the MAC (not the ZPIC) that conducts the medical review prepayment review. Con- versely, if the prepayment review falls under the category of "Benefit Integrity," then the contractor (the ZPIC) does not have any set time line within which to make a determination. WHAT IS THE LENGTH OF TIME FOR A PREPAYMENT REVIEW? Normally, the provider will be on a prepayment review until its charge denial rate (CDR) is less than or equal to 20%. Let's say that the provider is initially placed on 100% prepayment review. Once its CDR drops below 75%, then the review should be converted to a targeted review. In a targeted review, the contractor will review a portion of claims based on the provider's CDR. This process should continue until the provider's CDR equals to or is less than 20%, at which time the prepayment review should terminate. HOW DO I GET OFF A PREPAYMENT REVIEW? The goal of the provider is to reduce its CDR. The provider needs to thoroughly review its documentation to ensure that it supports the submitted claims. The provider should open up a line of com- munication with the contractor's auditor. If the provider is initially on a 100% prepayment review, then the provider should try to con- vince the auditor to limit the prepayment review to a set number of claims and/or to limit the review to a set time period. The provider needs to push the auditor to make claims determinations as quickly as possible. If necessary, the provider should go over the auditor's head and speak with the contractor's district/regional manager. If necessary, the provider should go over the contractor's head and speak with CMS. If necessary, the provider should ask its elected officials to contact the contractor on behalf of the provider. HME Jeffrey Baird Jeffrey S. Baird, Esq. is chairman of the Health Care Group at Brown & Fortunato, P.C., a law firm based in Amarillo, Texas. He can be reached at (806) 345-6320 or jbaird@bf-law.com. 13 LETTER TO THE EDITOR