During tough times tough decisions need to be implemented. Many healthcare practitioners and providers have been facing reduced reimbursements mainly affected due to the emerging and changing healthcare rules and regulations.
Three main problems faced by healthcare providers are:
- Reduced reimbursement from all payers
- Noticeable decrease inpatient footfalls due to increasing market competition and the tough economy
- Increase in Administrative and practice operating costs
Commonly, physicians are known to provide certain ambulatory items to patients only in the office such as crutches, canes, walkers, and folding manual wheelchairs, and only if the arrangement meets the requirements of an applicable exception to the Stark self-referral prohibition. Other DME items are prohibited unless the physician is licensed as a DMEPOS Supplier by NSC and documents personal compliance with all professional suppliers and quality standards. Physicians cannot seek reimbursements for DMEs dispensed to Medicare or Medicaid patients under the “Stark Law” or “physician self-referral ban,” as well as the Medicare Supplier Standards.
Thus the need arises for physicians to venture into other modes of generating revenue opportunities with their own patient base while they maximize patient clinical outcomes.
There are very simple ways to handle this and be fully compliant with healthcare federal and state regulations. Following proper guidelines, correct protocols & processes that adhere to the regulations, a lot of monetary as well as clinical benefits can be accrued. This can be implemented either in-house or better still outsource just the DME dispensing process, and thus maintain an efficient Revenue Cycle Management (RCM)process that brings in healthy revenues.
- Obtain a valid DME PTAN supplier number
- Implement and be updated with the Legal Compliance Program to meet all the Stark Act & Anti-Kickback Statute Guidelines
- Implement automation so as that all critical forms and processes are fully compliant
- Be fully aware of all profit-sharing guidelines amongst owners and partners
- Follow stringent processes to avoid spot audits and fraud implications
- Set up or outsource a more effective medical coding, billing & Collection System
- Ensure an efficient Practice Management System that maintains all Reports required for audits
- Ascertain Credentialing with Commercial Payers Surgical & Non-Surgical Protocols Operational Forms, Policies & Procedures to avoid fraud abuse
The above ensures prevention against any missteps or barriers that can occur in your RCM process. Efficiently executing a complete billing and accounts receivable management specific to DME with a completely trained staff or outsourced vendor who understands DME rules and ensures you are fully HIPAA compliant, you are all set to increase your profitability and focus on your core practice thereby maximizing patient clinical outcomes.