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WAMES 2012 Conference Edition Newsletter
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Sept. 25-27, 2012 at the Marriott Madison
West, Middleton, WI
W I S C O N S I N A S S O C I A T I O N O F M E D I C A L E Q U I P M E N T S E R V I C E S
Presents the
Convention & Trade Show
Agenda
29th Annual
Co-sponsored by the Wisconsin Society for Respiratory Care
2012 Conference & Trade Show EditionWAMES 2012 Annual Conference Charity
2 W A M E S O U T L O O K September 2012
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3September 2012 W A M E S O U T L O O K
Table of Contents
Grow Your Oxygen Business 4Think disease management
K0823 Prepay Review Rates Still High 5What are you doing to prepare for the new environment?
Meet Medical Necessity for Oxygen 6Medicare requires layers of documentation
Competitive Bidding and the HME Industry 11
From Hospital to Home Dependent n a Ventilator 12
The van Halem Group Drafts White Paperto Senate Finance Committee 14
Hunger in Southern Wisconsin 6WAMES is supporting Second Harvest Foodbank of Southern Wisconsin at the 2012 WAMES Annual Conference
Retail Sales Attitude Adjustment 19
Caring for the Neuro-Muscular Impaired Client 21
NIV Management of the Peri/Post Operative COPD Patient 23
WAMES 2011 Associate Members 28
WAMES Board of DirectorsPresident , Randy Lutz
ThedaCare At Home, NeenahVice President, Beau Hoy
Lincare, Columbus, OHSecretary, Sharon SuchomelThedaCare At Home, Neenah
Treasurer, Nick Bach, Lincare, Lake Geneva
Past President, Jean McAdamsCommunity HME, BarabooDirector, Gene Engelhardt
Homecare Pharmacy, BeloitDirector, Dave Hanson
Mercy Assisted Care, JanesvilleDirector, Dennis Iles,
Community HME, BarabooDirector, Val Larmer
Phillips Drug Store, MaustonDirector, Donna Smith
Home Care Medical, New BerlinDirector, Jim Spellman
Home Care Medical, New BerlinDirector, Tom Voegele
Bay Pharmacy, Sturgeon BayAssociate Board Member, Rob Clear,
The MED Group, Lubbock, TX
StaffExecutive Director
and Outlook Editor, Ann Barrett
Any reproduction or reprint of this guide, or portion thereof, without written permission from the Wisconsin Association of Medical Equipment Services is prohibited. Information is subject to change without notification. Please contact WAMES if you have questions about Outlook content.
WAMES c/o Ann BarrettP.O. Box 389Wild Rose, WI [email protected] or fax 715-366-4501
D r. Mary Schroth is a nationally recognized consultant for the care of patients with SMA and related pediatric neuromuscular diseases.
She is a Pediatric Pulmonologist and Associate Professor of Pediatrics at the UW School of Medicine and Public Health. Dr. Schroth will present on Wednesday morning, Sept. 26 in the Respiratory Track for WAMES. She will give a clinical overview of neuromuscular disease with an emphasis on pediatrics and SMA and discuss what it takes to keep these children in the home safely and how DME can help.
Oxygen Whenever, Wherever
The small, quiet and reliable Invacare® XPO2™ Portable Oxygen
Concentrator gives your patients the freedom to go wherever their schedule takes them. Whether relaxing at home or taking an extended trip, including air travel, the XPO2 Concentrator meets their oxygen needs.
For more information, visit www.invacare.com/oxygentherapyor call 1.800.333.6900.
www.facebook.com/InvacareCorporation©2012 Invacare Corporation. All rights reserved. Trademarks are identified by the symbols ™ , sm and ®. All trademarks are owned by or licensed to Invacare Corporation unless otherwise noted. Form No. 12-468
Invacare® XPO2™ Portable Oxygen Concentrator
120823_XPO2AD.indd 1 8/24/12 8:34 AM
5September 2012 W A M E S O U T L O O K
Whether you’re a fan of health care reform or not there are provisions contained within the law that have
gained broad bipartisan support and are being embraced by third party insurers as well. One such provision has created an opportunity for clinically focused respiratory providers. Section 3025 of the “Patient Protection and Affordable Care Act” mandates that beginning in 2015, hospitals will be financially penalized when COPD patients are excessively readmitted within 30 days of discharge — so called “value-based purchasing” — a situation that can cost each hospital millions of dollars. Obviously this has prompted hospital administrators to seek ways to ensure that certain patient populations, including those with COPD, remain stable and at home after they are discharged from the hospital. As a result, hospitals will be focusing more clinical resources to ensure that COPD patients are proficient in medication self-administration, recognition of early signs of exacerbation, understanding how to use their home oxygen system, aerosol device, positive airway pressure devices, as well as other home respiratory and medical equipment. However, the reach of those resources ends at the hospital’s front door. Yet the hospital is responsible to keep that patient stable for the next 30 days. Hospitals need partners, experts in the management of COPD patients who are capable of reaching those very patients in their homes.
As a result of these health care policy changes, a marketing opportunity has emerged. Discharge planners, case managers and social workers are typically tasked with coordinating patient discharges; now they have also been burdened with
identifying ways to reduce readmissions. Healthcare practitioners in these positions are recognizing the need to use all of the potential products and services that can help improve outcomes for these patients. Clinically focused DME providers can now position themselves as partners in assisting the hospital in its efforts to reduce readmissions. In fact, there is a growing body of medical literature that identifies the significant impact the DME providers can have on reducing COPD readmission rates.
At first glance it appears that the Affordable Care Act has created the perfect storm for the DME provider, hospitals and patients. Patients want to remain at home, and hospitals now have a financial incentive to keep them there, but DME providers are faced with significant financial constraints resulting from National Competitive Bidding and the 36-month cap on oxygen payments. For many providers these reductions in revenue are perceived as barriers and used as justification for not embracing a clinical model that could contribute to reducing patient readmissions. This creates a market advantage for providers that have eliminated costly non-value added services. By reducing operational costs providers will have the resources to invest in or maintain their clinical services.
Simple, efficient DME-driven disease management programs incorporate face-to-face, patient-clinician education, titration of pulse-dose delivered oxygen, written materials and telephone follow-up. Some providers, based on choice or market demands, add additional elements to these basic components. Regardless of the level of simplicity or complexity, disease management programs will become part of the new norm as hospitals look for solutions to their readmission challenges. Disease management programs differentiate providers from equipment suppliers and create significant marketing opportunities. Providers that embrace this model early will enjoy a competitive advantage, an opportunity to grow their market share and a chance to positively impact the lives of their patients.
Bob Messenger, RRTManager, Respiratory EducationInvacare Corporation
Grow Your Oxygen Business Think disease management
Hospitals need partners, experts in the management of COPD patients who are capable of reaching those very patients in their homes.
6 W A M E S O U T L O O K September 2012
K0823 Prepay Review Rates Still High
Medicare continues to conduct a widespread prepayment medical review for power wheelchairs identified by HCPCS code K0823 and their related accessories. Claims from multiple suppliers are being reviewed on a quarterly basis to assure that all
coverage criteria and documentation requirements are being met.The current power mobility device (PMD) Local Coverage Determination and policy
article have now been in place for almost 7 years and the claim error rate is still alarmingly high. The rate ranges anywhere from 55 percent up to nearly 90 percent in the different Jurisdictions around the country each quarter. Medicare will continue with these reviews until the denial rates are within a reasonable range and the current rate is nowhere near reasonable.
In the second quarter of 2012, Jurisdiction B processed 802 claims for K0823 power wheelchairs and their related accessories. Of those claims, 747 were developed for additional documentation and 640 were either completely or partially denied resulting in an 86-percent claims error rate.
The most common reasons for the K0823 denials in the second quarter are listed below:n The requested medical records did not establish medical necessity for the PWC
(64 percent). Most often the Local Coverage Determination basic coverage criteria were not met. The basic coverage criteria include: identifying the patient’s mobility limitations and their inability to use a cane, walker or manual wheelchair to meet their mobility needs.
n The required seven element order or detailed product description was invalid or incomplete (16%).
n There was insufficient evidence that a physician face-to-face mobility examination occurred.
n There was insufficient evidence to prove the beneficiary could not use a power-operated vehicle.
n There was no response to Medical Review’s request for additional information to support the claim.
It is important for suppliers to understand and follow the DMEPOS Supplier Enrollment Standards. A large number of suppliers fail to respond to requests for additional documentation from a Medicare contractor and this is a violation of Supplier Standard No. 28. Medicare regulations stipulate that a supplier is required to maintain documentation for seven years from the date of service and provide access to that documentation when requested by either CMS or a Medicare contractor. Failure to provide records may not only lead to a claim denial or recoupment of a previously paid claim, but may also lead to a referral to the National Supplier Clearinghouse for possible sanctions. I can’t understand how anyone can afford to let their PMD claims be denied by not responding but there is much more at stake than just a claim denial now that potential NSC sanctions are coming into play.
Join me for my sessions on PMD Documentation and Overcoming Audits where we will discuss tips and strategies on how to avoid the common pitfalls that challenge so many mobility providers. We need to start chipping away at these bloated PMD claim error rates so CMS and the Medicare contractors can switch their attention to someone other than us for a change. See you in class!
Jim StephensonInvacare Corporation
A large number of suppliers fail to respond to requests for additional documentation from a Medicare contractor and this is a violation of Supplier Standard No. 28.
7September 2012 W A M E S O U T L O O K
By Sarah Hanna
For many providers, oxygen is the lifeblood of their revenue cycle. But Medicare is making it increasingly
difficult to keep the oxygen cash flow in a positive state.
We have CERT, pre-pay audits, Additional Documentation Requests (ADRs) and also more complicated redeterminations and reconsiderations to validate a patient’s medical need.
Remember the good old days when a Certificate of Medical Necessity (CMN) sufficed as proof of medical necessity? Unfortunately, our new reality involves chart note documentation from referral sources.
Providers should have the following documentation to prove medical necessity of claims: n A copy of the most recent Certificate of
Medical Necessity (CMN) dated before service started
n The treating physician’s detailed written order for DMEPOS items. CMN can serve as detailed written order if sufficiently completed.
n If the Date of Service (DOS) is before the signature date on the Detailed Written Order (DWO), proof of a dispensing order must be submitted
n Copy of the beneficiary’s most recent arterial blood gas PO2 and/or oxygen saturation test value reported on the CMN
n Documentation of a physician office visit before initial date of service; the physician’s office visit must be within 30 days of the initial CMN date or within 90 days of the recertification CMN date.
n Valid Proof of Delivery n Contemporaneous — within the past six
months — chart notes proving on-going need for oxygen after recertification
When responding to audits and documentation requests, many providers fall short on chart notes regarding the physician office visit before the initial date of service. This needs to occur within 30 days of the initial CMN date or within 90 days of the recertification CMN date.
Also pay attention to visit notes from the physician because many providers are being denied on medical necessity redeterminations and reconsiderations because they lack of the 30- and 90-day visit notes proving a patient was assessed and requires oxygen.
In a recent oxygen prepayment audit completed by NHIC Corp., the Jurisdiction A DME MAC, 56.3 percent of the denied claims had problems because of visit notes. Problems included:n 26.9 percent of the denied claims were
missing treating physician visits — within 30 days of initial CMN, or initial issue of oxygen
n 26.5 percent of denied claims were missing treating physician visits both for 30 days within the initial CMN and 90 days within the recertification CMN. (Initial issue of oxygen)
n 2.9 percent of denied claims were missing treating physician visits—within 90 days of the recertification CMN. (Initial issue of oxygen)
Staff members should be aware when working an audit, ADR or medical necessity appeal that the physician visit notes and the testing reports must meet criteria of the local coverage decision (LCD).
For any audit, suppliers will be sent a documentation request for information. The requested information must be returned within 30 days from the date of the letter to avoid claim denials.
For redeterminations and reconsiderations ensure that the visit notes are available as the DME MACs are looking for those when reviewing the medical necessity denial appeals.
To see if your referral sources can provide you with the notes you need regarding their oxygen visits, give them the “test.” Pick your top five to ten referral sources and request the notes. No. 1: Do they respond in a timeframe which you can meet the 30-day response time to an audit? No. 2: Do the notes meet the intent of the LCD regarding the oxygen visit requirements?
If your referral sources don’t pass the test, education is the way to compliant chart notes.
Reduce your take backs, by gaining the visit notes and meeting the CMN and LCD requirements.
Meet Medical Necessity for Oxygen Medicare requires layers of documentation
10 Best Practicesfor HME patient Collections
Is your AR piling up? How does your DSO look? Are your patients responding to their statements or ignoring them? Is your billing staff stressed out and needing a little “patience” with the “patients?”
Here are a few tips and tricks of the trade that will help increase cash flow, lower that DSO, and at the same time, create a productive billing process and, hopefully, a happier billing staff.
Collect a Credit Card Up Front, For Crying Out Loud.Success at the initial meeting with the patient is spelled with 3 “C’s”: Credit card, Copay, and Collect.
It’s not always popular with patients to collect a copay on the spot, but Providers need to take advantage of that initial conversation to collect payment while they have patient attention. The longer you wait to inform the patient of their financial obligation, the more costly your labor becomes to collect on that account.
Create a ScriptCollecting a credit card or copay upfront requires a careful conversation. Make it easy for your staff to be approachable and confident in gathering information with a powerful tool full of step-by-step directions and do’s and don’ts to follow in the conversation - the script. FAQs and resolutions to possible scenarios are also beneficial for your staff.
Get to know your ARYou don’t need to have an icebreaker with your AR, but definitely get to know it. Run a report out
of your billing software weekly and share these numbers with your billing staff. Knowing where the outstanding AR lies, whether patient-pay AR or insurance AR, will help your staff focus on where to collect.
AutomationAutomating your billing process - everyone is talking about it. I know your Mama asked if you if you would jump off a cliff just because everyone else was jumping, but this time, you really need to jump. Leaping into the new world of automation will streamline the billing and collection process and save valuable time by eliminating manual labor involved in reporting, reviewing and sending out invoices. This saved time will allow your staff to concentrate on higher payoff activities. Geronimooooo!
Invoices Are the New StatementsWhat’s the difference between statements and invoices? Everything. Statements are confusing and typically not easy to understand. The right type of bill is simple to read, clear and concise, and is sent out in a timely manner. It will not
Telling it like it is.
Or at least like it should be.
overwhelm the patient and cause them to ignore it, waiting for the bill with the correct amount due to arrive. Enter the invoice. A customized invoice for your patients will change the way your patients see their financial responsibility and change the way they pay. An invoice is like a cheat sheet for a statement; it breaks down the patient’s financial responsibility to an understandable level in a timely fashion. Make the switch. Your staff will thank you.
Automate Your Phone CallsNearly everyone owns a phone today - why not use it to your advantage? Automate your phone calls and quit playing the manual “dialing for dollars” game your staff has to play when a patient does not make payments or respond to their bill. Implement automated calls and reduce labor instead of increasing it.
Use Phone Collection AgenciesLet them do the dirty work. Free up your staff and let the professionals collect. Enough said? We think so.
Offer Online PaymentsThe computer-savvy generation is growing up and going to need a quick and easy solution for making payments. Give these laptop-carrying, cell phone-toting, tech-loving individuals the ability to make a secure payment online with a few taps on their keyboard. Not only will you reduce paper use, you’ll also reduce the labor it takes to individually process a payment. Online payments save time, are convenient for your patients, project a professional image, and boost credibility of your business to your clientele.
Dot your i’s and cross your T’sIf a patient has to call you and point out errors on their bill, good luck convincing them to give you any money. You have to be consistent and detailed in order to gain patient trust and, subsequently, their money.
Payment PlansThe easiest way to get someone to do something is to put them on a schedule. The same is true for getting patients to pay. Make it hard for them to come up with an excuse about why they paid late with an automated payment plan.
Ready to make a change? We’ve got the gumballs to help you do it.
Visit us online at www.strategicar.comor call 914-744-3360 to schedule a demo and see how you can start slashing AR, demolishing DSO, and getting your patients to pay.
©2012 Strategic AR 10800 Farley Street Overland Park, Kansas 66210 913-744-3360 www.strategicar.com
10 W A M E S O U T L O O K September 2012
• Buying groups for HME, complex rehab, respiratory and home modi cations providers.
• An active, aggressive government relations department that is well-known in the industryand on Capitol Hill.
• Participation in national managed care contracts through HOMELINK.®
• An unparalleled online education program that offers courses for all parts of an HME operation.
• Insurance and lease/ nance programs that are tailored for the HME industry.
• Technology consulting, including eet management tools that can save you time and money.
• Marketing assistance, from HME-speci c websites to print pieces that will make you look good!
• A variety of valuable business services ranging from online billing to communication solutions.
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Visit www.vgm.com or call 1-800-642-6065.
11September 2012 W A M E S O U T L O O K
Health care as we know it is changing, and it is no doubt affecting the home health care sector. Many of those health care changes are being seen with the enactment of the Affordable Care Act (ACA), which also included changes to the HME industry.
Some of the provisions of the ACA include expanding competitive bidding, requiring competitive bid pricing be applied nationwide as early as 2015, and imposing an excise tax on medical devices. And this only names a few.
Of course, one of the biggest issues and changes to the HME industry is competitive bidding. By now, virtually the entire HME industry is familiar with CMS’ controversial program. Most are aware that more than 200 world-renowned economists and auction experts say that the program is doomed for failure. And studies highlighting the deeply flawed program continue to surface. Recently, economist Ken Brown, Ph.D. released a report studying the effects of competitive bidding to rural states like Iowa. Another report was recently done by an accounting firm discussing their findings on CMS’ beneficiary hotline, 1-800-Medicare. But in spite of the concerns being expressed by economists and the industry, CMS continues to move forward with the program.
It’s no secret that our industry has fought for a number of years to stop competitive bidding. The long and often up-hill battle has perhaps left some with a sense of apathy. We should be reminded, however, that perseverance brings success. As industry leaders, including your own state association, as well as providers continue knocking on the doors of Congress, more are waking up and hearing our concerns. More traction is being made, and more of our Congressional members agree that this program must be stopped.
We must also remember that although business is clearly different than it was in the past, the future for HME providers does not have to be doom and gloom. Demand for home medical equipment is incredibly strong, and will be for a long time. As we continue in our fight to stop competitive bidding, we must also look to adapt to the changing health care. As health care evolves, HME companies can evolve, looking into new opportunities including transitional care, remote patient monitoring and health coaching — all of which would potentially provide cost-saving opportunities for Accountable Care Organizations.
We look forward to visiting with you at the upcoming WAMES Annual Conference and Trade Show to discuss not only where we are with the fight against competitive bidding, but also where we can go post-competitive bidding. The future of HME is bright. We mustn’t give up now.
Ron Bendell, PresidentVGM & Associates
John GallagherGovernment RelationsThe VGM Group
Competitive Bidding and the HME Industry
It’s no secret that our industry has fought for a number of years to stop competitive bidding. The long and often up-hill battle has perhaps left some with a sense of apathy. We should be reminded, however, that perseverance brings success.
12 W A M E S O U T L O O K September 2012
The decision for a tracheostomy is a difficult decision for families to make. Once the tracheostomy is placed they are informed of all the bedside teaching and equipment teaching they have to learn for their child to go home. This often makes the caregivers
a little uncomfortable/nervous. As teaching begins and proceeds the caregivers either slowly get more comfortable or move along quickly.
The role of the RCP, as a member of the Tracheostomy/Home Ventilator Team, is very important to help the caregivers become more comfortable and competent in their child’s care.The RCP will explain to the family what they will be learning; some find it difficult to imagine they will be able to learn the equipment in a couple of classroom sessions. The RCP explains all the equipment they are going to learn. How to clean it, set it up, change out disposable supplies and troubleshoot alarms. Many caregivers leave this classroom session feeling very overwhelmed and feel they won’t be able to learn this in such a short time. Caregivers are assured they work with the RCP until they feel comfortable. The best way to get them comfortable especially with a ventilator is to work with the RCP at the bedside practicing giving treatment, bypassing the heater to the HME. They also practice placing all the equipment on to the stroller and then walk alone on the unit with their child; with all the doctors and nurses available to them should they need assistance. The final step is taking their child off the Unit with all of the equipment.
Taking the child off the Unit is a big step for both the caregivers and the child. Often the children have been hospitalized for months and have rarely been out of their room. Feeling the sun on their face is sometimes both surprising and frightening for the child. These walk and practice at the bedside is the most important steps in preparing the child and family for home. To see the change of a nervous caregiver to a much more confident one is a great feeling to know that you have helped this family get their loved one home.
Lori LeiserCRT
From Hospital to Home Dependent on a Ventilator
13September 2012 W A M E S O U T L O O K
Automate. Achieve Insight. Gain Control.Brightree’s innovative web-based billing and business management solution delivers advanced process automation and intuitive business intelligence so you can run your business at peak performance.
With more control of your business, you see more cash coming in the door.
See the difference for yourself, and learn why more providers switch to Brightree. Visit the Brightree exhibit at WAMES today.
www.brightree.com • Call 1.888.598.7797 Ext. 5© Brightree LLC. All rights reserved.
14 W A M E S O U T L O O K September 2012
Earlier this year, the Senate Finance Committee, led by Ranking Member Orrin Hatch (R-Utah) and Chairman
Max Baucus (D-Mont.), announced a bipartisan effort to begin soliciting ideas from interested stakeholders in the health care community regarding effective solutions to improve federal efforts to combat waste, fraud, and abuse in the Medicare and Medicaid programs. In an open letter to members of the health care community, the Senators wrote, “We believe federal efforts would be strengthened by input from members across the health care community — providers, payers, health plans, contractors, non-profit entities, consumers, data analytics entities, governmental partners, and patients. Drawing on the collective wisdom and accumulated insights of thousands of professionals and individual experiences could offer a fresh perspective and potentially identify solutions that may have been overlooked or underutilized.”
The lawmakers invited interested stakeholders to submit white papers offering recommendations and innovative solutions to improve program integrity efforts, strengthen payment reforms, and enhance fraud and abuse enforcement efforts. Drawing from their collective knowledge as former fraud investigators, auditors, and clinicians, the leadership team at The van Halem Group, LLC — a firm specializing in Medicare compliance, audits, appeals and medical review — combined their unique knowledge and insights to prepare a special audit White Paper. Consultants at The van Halem Group regularly support clients through intense regulatory oversight and collaborate with oversight entities on streamlining the audit process. “While we communicated with other industry stakeholders prior to this submission, we elected to submit our own response to highlight the fact that our thoughts and ideas are based upon our unique
backgrounds,” said Wayne van Halem. Using this experience, they identified nine areas for improvement within the current Medicare audit system.
To read the report in its entirety, please visit www.vanHalemGroup.com. The following is a summary of the points and recommendations made within the White Paper:
Lack of oversight of Medicare Zone Program Integrity Contractors (ZPICs)Recommendations: n CMS should employ, or at least educate
and train, staff that are qualified in and familiar with healthcare operations, coverage policies, and healthcare fraud investigative techniques to oversee program integrity workload and contractors.
n CMS staff should be regularly involved in the decisions being made by government contractors.
n CMS should implement a process for providers undergoing audits to be able to communicate with them if faced with issues they have been unable to resolve with the contractor.
Lack of trust between provider community and CMSRecommendation:n Implement programs which encourage
participation and cooperation from provider groups and entities as well as CMS, similar to this request, which allows input and communication from other stakeholders in the healthcare industry.
Lack of Clinical Judgment in conducting claim reviewsRecommendation:n Reinstate the section of the CMS PIM
that allows contractors’ clinical staff to apply their expertise to the claim records review process.
Lack of Experience and Training of ZPIC staffRecommendations:n Better train and educate ZPIC staff to
identify fraudulent practices, develop more solid referrals and recoveries, and provide a better return on investment.
n Encourage investigators to gain field experience by going into the field and visiting providers and patients.
n Make program integrity networking groups a key element for each Zone of every ZPIC.
Intense focus on Clinical Records for Ancillary ServicesRecommendations:n Provide funding to educate referring
physicians and CMS contractors.n Hold physicians accountable for the
services they prescribe.n Audit the referring provider as well as
the ancillary provider.n Implement the use of approved forms
to document medical necessary of ancillary services.
n Consider current documentation dated after the specific date of service in question.
The van Halem Group drafts White Paper to Senate Finance Committee
15September 2012 W A M E S O U T L O O K
Absent or Complex Prepayment PoliciesRecommendations:
Develop more consistent and precise coverage rules and policies throughout the country for all services billed to Medicare.
Prepayment Review of ClaimsRecommendations:n CMS should implement clear and concise guidelines for all contractors that perform
prepayment reviews.n CMS should measure a contractor’s understanding of the data and have input in the
analysis.n Draft policies and guidelines on when it is appropriate to implement a 100%
prepayment review, as well as very strict and clear instructions to contractors on timeliness and removal of the edit.
n CMS staff should be involved and aware of the prepayment review process and be monitoring it closely.
n Contractors should correct their errors. If a claim is denied erroneously by a ZPIC contractor, it should be reopened and corrected by the contractor, as opposed to utilizing the appeals process.
Increase funding and focus on innovation and enrollmentRecommendations:n Implement more precise payment policies and processes.n Create a national, accurate, complete and centralized claims database.n Developing and implementing new and innovative techniques must be a performance
measure for CMS contractors.n Maintain focus on provider enrollment to assure that individuals entering the Medicare
program plan to participate properly. n Increase the education and training for the front-line individuals responsible for
processing enrollment applications, andn Implement a prepayment process for all new providers for a specified period of time.
Increased beneficiary education and accountabilityRecommendations:n It is important for CMS to infiltrate and provide easily understandable educational
information to both ethnic and low income beneficiary groups. Included in this information should be education and communication on the beneficiary’s role and responsibility in their care and their benefits; up to and including their liability if they participate in or are negligent in reporting potentially fraudulent activity.
n Increasing the accountability for the Medicare beneficiary in the care and treatment they receive will lessen the burden on providers and reduce the risk of claims being submitted that are not necessary. For example, if the oxygen patient is made aware up front of the reevaluation requirement, but does not comply, they should be made liable for those services for the non-compliance and the notification of the requirement would serve as the advanced notice. If they don’t need the equipment and don’t comply, they will either return it or be required to pay for it themselves.
Wayne H. van HalemPresident — The van Halem Group, LLC
1. There are 6.5 CEUs to be earned in the Respiratory Track and 6.5 in the Rehab Track
2. There are more than 45 exhibiting companies bringing great products and services you should see
3. There are excellent speakers including an doctor this year from UW School of Medicine, Mary K. Schroth, M.D.
4. The Exhibitor’s reception is great fun with food, beverage, prizes and a silent auction – bring staff for free with one paid registration!
5. There are new contests at the Golf Outing and an awesome goody bag
6. Hear great sessions on Medicare, Competitive Bidding, Neuromuscular disease, COPD, Billing, Audits, Accreditation and more
7. We are next door to Greenway Station where you can enjoy great restaurants and shopping Thursday evening
8. Everyone is welcome to attend the Golfer’s reception on Tuesday evening at Pleasant View golf course, simply RSVP
9. New this year we are partnering with Second Harvest Foodbank with a Food Drive
10. Lots of great education and networking to improve your company’s bottom line!
To register call Ann at 715-366-7500 or register online at www.wames.org. See you there!
There are at least 10 reasons to attend the 29th Annual WAMES Convention and Trade Show:
17September 2012 W A M E S O U T L O O K
WAMES is supporting Second Harvest Foodbank of Southern Wisconsin at the 2012 WAMES Annual Conference
Hunger in Southern Wisconsin
Second Harvest Foodbank of Southern Wisconsin is a nonprofit organization dedicated to ending hunger in southwestern Wisconsin through community partnerships, serving nearly 141,000 people who struggle to put food on the table. Through food
and financial donations and volunteer support, Second Harvest Foodbank acquires and distributes food to 300 partner agencies, including food pantries, shelters and meal sites, in 16 counties.
WAMES is conducting a food drive for the Second Harvest Foodbank and will have barrels and collection containers at the Annual Conference on Sept. 26-27 at the Marriott Madison West in Middleton. Please consider bringing donations of non-perishable food or personal products or a monetary donation.
Dan Stein, the President and CEO of the Second Harvest Foodbank of Southern Wisconsin will address conference participants and further explain their mission.
Most Needed Non-Perishable Food and Non-Food Grocery Items
Here are the non-perishable food and non-food grocery items most needed by Second Harvest Foodbank’s partner agencies that assist families and individuals struggling with hunger:
FOOD ITEMS NON-FOOD ITEMSPeanut butter Disposable diapersTuna Laundry detergentJelly Facial tissueComplete meals in a can (stew, soup, pasta) Toilet paperComplete pancake mix Plastic bags (food storage)Syrup Liquid dish soapJuice (100% fruit) Baby wipesCereal Bar soapComplete meals in a box (Tuna/Hamburger Paper towelsHelper, macaroni & cheese, etc.) Tooth brushes and pastePotatoes (boxed/dehydrated) ShampooDry pasta DeodorantTomato/spaghetti sauce Canned fruit and applesauce CrackersBeans (pinto, black, kidney)RiceCanned vegetablesRamen noodles
Second Harvest can provide one meal for every 1.2 pounds of food and three meals for every $1 donated.
From July 1, 2011 through June 30, 2012, Second Harvest Foodbank distributed 9.8 million pounds of food. It is one of 200 members of Feeding America, the nation’s leading domestic hunger-relief charity.
For more information, visit www.SecondHarvestMadison.org
19September 2012 W A M E S O U T L O O K
A s DME managers and business owner’s peer into the future they often wonder how they can escape the assault by
Medicare and other insurers on their business. Often the thoughts go to building cash business through expanding their retail sales program. Retail sales have become a popular subject at trade shows. These programs provide good information on products, advertising, store displays etc.
I contend that that the number one limitation to a DME company’s success in retail sales is the inability to change the philosophy throughout the organization. I’ve had the opportunity to survey dozens of companies that have significant retail sales programs. These companies have good size sales floors, a nice product selection and reasonably good locations. In the most successful of these stores I have seen a cash sales attitude.
One of the best examples, or should I say worst examples I have observed went like this. A mother came into the retail store to purchase an ankle brace for her daughter who had a mild sprain. The customer service representative (CSR) spent a few minutes with her and they chose a brace which sold for about $50. The CSR and the customer walked up to the sales counter and the mother pulled out her check book and started to fill out the check. The CSR said “oh you don’t have t do that, we can bill your insurance.” The mother said that’s “alright I’ll just pay for it now.” The CSR insisted she can contact the doctor for a prescription and bill for the ankle brace. The mother relented and agreed and took the product and left the store.
This owner went to the expense to put his store in a good location, stocked the merchandise, paid the advertising and pay the CSR. With the time spent acquiring
the prescription, billing the insurance, accepting the insurance allowable, billing the patient for the co-pay, then hoping the customer pays the co-pay; the CSR just took a sale that would be a modest profit to a sale that will loose money.
Maybe the most unbelievable part of the story is when I relayed the account of the sale to the owner he did not understand what the problem was.
A change in philosophy is needed in the industry and by individual stores. It has long been the belief that senior citizens are poor and they must have health insurance in order to receive healthcare products. The truth is that senior citizens have the most disposable income of any age group. Certainly many of our clients have significant health and financial issues but many more have disposable income and less severe health issues. The products we supply can improve their comfort, mobility and quality of life; as an industry we need to do a better job of getting our products into the homes of our customers. The process begins with not being afraid to separate a customer from their money in exchange for products they can use. Some may call this attitude greed, others will call it good business, and in our trade many will call it survival.
Once a change in attitude is accomplished, then the floor sales and phone techniques used by successful full service retailers can be put in place. Good sales techniques will boost non-assigned insurance sales; add on sales, and up selling to more expensive products. So when looking to increase cash sales, committing to added space and more merchandise; first consider an attitude adjustment.
Dana AdamsValley Consulting Inc.
Retail Sales Attitude AdjustmentCertainly many of our clients have significant health and financial issues but many more have disposable income and less severe health issues.
20 W A M E S O U T L O O K September 2012
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21September 2012 W A M E S O U T L O O K
Care of the neuromuscular-impaired client is special, in many ways.
Whether infant, pediatric or adult in age, working with these clients and their families and caregivers, offers experiences that are both rewarding and challenging. The emotional and work ‘highs and lows’ can be profound and the DME-client relationships are deeper than usual. Many continue for years, often after the client’s demise.
Families tend to be quite well versed and supportive in both the medical and equipment aspects of care for their loved-ones. Support groups, disease-related clinic visits and “Dr. Internet” are frequently used resources — sometimes to the frustration of physicians, clinicians and equipment providers.
While final diagnosis can be elusive
Caring for the Neuro-Muscular Impaired Client
at times, and discharges sometimes complex, once these clients are stable in their residential environment, they may function quite independently for months or years. The role of the equipment supplier is then commonly relegated to routine deliveries. Changing brands or models, esp. as equipment becomes obsolete or not repairable, may well be the largest challenge.
Unlike the traditional insurance and reimbursement models, and likely outside of the [current] Competitive Bidding programs, equipment and other coverage may be available via disease-specific categories. A diagnosis of ALS, as an example, may qualify the client for airway pressure therapy devices without the usual sleep study requirements.
Clinicians — whether Nurses, Respiratory
Therapists, OT, PT, ST, Dieticians, Case Managers and others — bond with the client early in the continuum of care, and much more as the disease progresses. Each brings expertise to meet changing needs of the clients. Of necessity, teamwork optimizes the ‘wellness’ of each person.
Persons and companies who chose to provide care and services for the clients who have neuromuscular challenges, are often perceived to have above average employees, skills and services. The resultant rewards are seen professionally, financially and personally — and the gratifications are priceless.
Kathy Lester-RossRRTInspiraTech
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22 W A M E S O U T L O O K September 2012
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What We Do:Lake Court Medical Supplies, Inc is a wholesale medical supplier specializing in “just in time delivery”. We seek to build long-term partnerships with our customers by providing quality products, timely deliveries, competitive prices and a level of service unmatched in the industry. Since 1991, the measure of our success has been determined by the success of our customers. Our website better meets the needs of busy healthcare professional who want product information that is just a click away. Take a moment to surf our site and see what we can do for you. www.lakecourt.com
• Respiratory Equipment• Respiratory Disposables• Wheelchairs• Incontinence• Urological Supplies
What We Offer:• Ambulatory Aids• Bath Safety• Beds and Accessories• Power Mobility• Lift Chairs/Recliners• Pressure Management
“Lake Court Medical is built for speed, and it’s built to serve our clients needs better than any of our competitors. In the coming months the company is investing in new technology, allowing us to compete in more markets, while also providing us with greater speed, and information.”
Charlie Elliott - President/CEOLake Court Medical
Supplies, Inc
WWW.LAKECOURT.COM • 1-800-860-3130
Exclusive AirLogic™ technology maximizes breathability and comfort with moisture-wicking fabrics and a patent-pending design. Technically advanced and durable in construction, AirLogic™ Anterior Trunk Supports adjust conveniently, move comfortably and clean easily. Sporty design details, heavy-duty stitching and swiveling buckles deliver everything your clients ever wanted in an anterior trunk support.
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Learn more at AELseating.com | 866.656.1486Stretch, Non-Stretch and Zippered designs in Standard-Cut or Slim-Cut styles.
23September 2012 W A M E S O U T L O O K
In operating rooms and hospitals across our country, surgeons, anesthesiologists and other health professionals are challenged every day in treating greater numbers of persons with underlying lung diseases, specifically COPD. Current data has shown that post-operative
cardio-pulmonary complications are on the rise. Chronic obstructive pulmonary disease (COPD) is a progressive pulmonary inflammatory disease that often manifests itself in multi-system co-morbidities. COPD affects many thousands of persons worldwide every year, and with it carries significant risk of cardio-pulmonary related complications, especially when going undergoing surgical interventions, sedation and pain management.
The condition of COPD is typically a result of either prolonged tobacco smoke exposure during the person’s lifetime, infections, exposure to environmental toxins or chemicals, genetic conditions, and other situations. It is often associated with significant damage to the conducting airways and alveoli within the lungs, and leads to significant inflammation, mucous production, and air trapping within the alveoli itself. As a result of the associated impaired ventilation and respiration capabilities of the cardiopulmonary system, hypoxemia and hypercarbia become of critical importance and need to be addressed. These persons often experience significant increases in their work of breathing, and often require medications, oxygen, NIV therapies, exercise and strength training, and more to ensure adequate ventilation and gas exchange.
And while the long-term survival of a person with moderate to severe COPD is limited, combining the condition with any type of surgery is often associated with increased cardio-pulmonary complications, further increasing the risk of mortality. Adding to that, these surgical complications often increase in risk when the condition of obstructive sleep apnea (OSA) is also present, as is seen in about 40percent of all COPD cases. Understanding the respiratory mechanics of a COPD patient, the risks associated with underlying and possibly unidentified OSA, and applying appropriate ventilation management techniques are of critical importance.
The primary goals of peri-post operative ventilation management are to properly pre-identify persons with higher risk for complications, develop appropriate care plans, allow for provisions for necessary interventions when needed, reduce the associated pulmonary risks of anesthesia and pain management ... and ultimately save lives. In more severe cases of COPD, often a multidisciplinary team is needed for developing appropriate interventions and care plans. Appropriate discharge planning of a post-surgical COPD patient is also of critical importance, but also carries some special therapy considerations for home non-invasive ventilation (NIV) therapies to ensure appropriate therapy is carried out and associated reimbursement of equipment and services is achieved.
Finally, implementation of pre-surgical screening programs for COPD, OSA and other ventilation abnormalities within the hospital setting is gaining additional attention worldwide. Organizations are seeing the value of developing strategic plans for pre-screening of these ventilation risks prior to the scheduled procedures, and are seeing their efforts rewarded. With effective pre-identification of associated risks, ventilation optimization and appropriate management of anesthetics and sedation, the risks of developing these serious outcomes can be significantly reduced for this critical population.
Please join us for this informational session on the NIV management of a COPD patient in the peri/post operative and homecare setting.
Rachel FergelResMed
NIV Management of the Peri/Post Operative COPD Patient
The primary goals of peri-post operative ventilation management are to properly pre-identify persons with higher risk for complications, develop appropriate care plans, allow for provisions for necessary interventions when needed, reduce the associated pulmonary risks of anesthesia and pain management ... and ultimately save lives.
25September 2012 W A M E S O U T L O O K
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To see if you qualify for a $250 Medicare Surety bond, or you would like information regarding other products and services, please contact us:
26 W A M E S O U T L O O K September 2012
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27September 2012 W A M E S O U T L O O K
Sponsors of the 2012 WAMES Annual Conference
Invacare Corporation— sponsor of presenters Lois Brown, Bob Messenger and Jim Stephenson
Strategic AR — sponsor of presenter Sarah Hanna QS1 — sponsor of presenter of Sarah Hanna Philips Respironics — sponsor of presenter Hank Hart The MED Group — sponsor of presenter Wayne Grau VGM & Associates — sponsor of presenters Ron Bendell
and John Gallagher Med-Stat USA, LLC — sponsor of presenter Jane Swoboda
Transfer Solutions, LLC — sponsor of presenter Ty Bello
Brightree — sponsor of presenter Wayne van Halem ResMed — sponsor of presenter Rachel Fergel Medical Alliances, Inc. — sponsor of presenter Kathy Lester-Ross JOBST — sponsor of the 2012 conference lanyards
Thank you to these sponsors — they help us provide you with quality education!
Sept. 25-27, 2012 at the Marriott Madison
West, Middleton, WI
Convention & Trade Show29th Annual
28 W A M E S O U T L O O K September 2012
WAMES c/o Ann BarrettP.O. Box 389Wild Rose, WI [email protected] or fax 715-366-4501
* ACU-Serve, John Stalnaker. . . . . . . . . . . . . . . . . . . . . . . . . . 800-887-8965 * Adaptive Engineering Lab, Brendon Reid . . . . . . . . . . . . . . 866-656-1486* Airgas, Ty Schmitz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262-786-4427* Bemis Manufacturing Company, Scott Thomson . . . . . . . 920-467-5465* Brightree, LLC, Wanda Ellis . . . . . . . . . . . . . . . . . . . . . .678-243-1800 x461* BSN Medical Inc., Tom Kastory . . . . . . . . . . . . . . . . . . . . . . 414-841-4157* Computers Unlimited, Daniel Greyn . . . . . . . . . . . . . . . . . . . 406-255-9538* DHC Healthcare, James Vana. . . . . . . . . . . . . . . . . . . .630-655-4000 x224* Dr. Comfort, Sharon Felber. . . . . . . . . . . . . . . . . . . . . . . . . . . 262-236-3412* Fisher & Paykel Healthcare, Bryan Matye . . . . . . . . . . . . . 414-350-9377* Healthcare Quality Association on Accreditation,
Gabriel Nicholas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 866-490-7980** Healthstar Associates, Inc, Barry Petrigala . . . . . . . . . . . . 847-673-9999* HP, Dave Miess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 608-224-6930* Inova Labs, Dreu Viola . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262-818-9898** Invacare Corporation, Dan Girard . . . . . . . . . . . . . . .800-333-6900 x1865* Invacare Supply Group, Hal Cunningham . . . . . . . . . . . . . . 508-634-5131* Lake Court Medical, Dan O’Neill. . . . . . . . . . . . . . . . . . . . . . 773-255-7773* LifeGas, Mike King. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 920-924-5719* Med-Stat USA, Dave White . . . . . . . . . . . . . . . . . . . . . . . . . . 262-754-3919* Medical Alliances, Inc., Bill Strange . . . . . . . . . . . . . . . . . . 952-470-5269
* Medline Healthcare, Keith Walsh. . . . . . . . . . . . . . . . . . . . . 800-Medline* MK Battery, Lilia Flores. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-372-9253** Nova Medical Products, Scott Deis . . . . . . . . . . . . . . . . . . . 800-557-6682* Pharmacists Mutual Companies, Laurie Harms. . . . . . . . . 515-295-7490* Philips Respironics, Barb O’Leary . . . . . . . . . . . . . . . . . . . . 414-267-7696* Precision Medical, Stormy Grinnell . . . . . . . . . . . . . . . . . . . 630-803-5910* Pride Mobility, Beth Plaisance Hill . . . . . . . . . . . . . . . . . . . . 800-800-8586* R & M Rehab, Don Goheski . . . . . . . . . . . . . . . . . . . . . . . . . . 262-754-0460* ResMed, Monte Koenig . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414-305-1192* Strategic AR, Jennifer Leon. . . . . . . . . . . . . . . . . . . . . . . . . . 913-744-3360* Sunrise Medical, Jeff Smith, ATP . . . . . . . . . . . . . . . . . . . . . 262-353-8700 * The Compliance Team, Inc., Rick Canally . . . . . . . . . . . . . . 215-654-9110* The MED Group, Rob Clear . . . . . . . . . . . . . . . . . . . . . . . . . . 405-250-9054* The Service Center, Patrick Sweet. . . . . . . . . . . . . . . .708-345-0894 x305 The van Halem Group, LLC,
Wayne van Halem, CFE, AHFI . . . . . . . . . . . . . . . . . . . . . . . . 404-343-1815** VGM Group, Derek Etjen . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-642-6065
** indicates WAMES Gold Associate Member* indicates WAMES Silver Associate Member
WAMES 2012 Associate MembersThank you for your support of WAMES
