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Moving the HME Industry Forward

Billing/Reimbursement

  • Paying Physicians - Guidance from Two Cases
    February 20, 2017

    AMARILLO, TX - Within certain legal parameters, a DME supplier can make payments to physicians. For example, if the supplier and physician enter into a legitimate Medical Director Agreement, then the supplier can make payments to the physician. Likewise, if a physician will provide bona fide education services for the supplier, then the supplier can pay fair market value (“FMV”) compensation to the physician. In entering into these types of arrangements with physicians, the DME supplier must avoid violating the Medicare anti-kickback statute (“AKS”) and the federal Stark physician self-referral statute (“Stark”). read more »

  • HIPAAwise.com and ACU-Serve Bring Billing/Compliance Wisdom to Medtrade Spring
    February 13, 2017

    LAS VEGAS – HME providers looking for powerful technology to boost billing acumen and HIPAA compliance should check out Booth #735 at Medtrade Spring. Attendees will find 20-year-old ACU-Serve right alongside newcomer HIPAAwise.com. read more »

  • Clinical Study - Be Aware of Kickback Problems
    February 13, 2017

    AMARILLO, TX - It is important for DME suppliers to be aware that they live in the proverbial “glass house.” As part of this awareness, suppliers need to understand two metaphors that govern an analysis of whether an arrangement is legitimate, or if it is simply a disguised kickback: “you can put lipstick on a pig…but it is still a pig;” and “if it looks like a duck, walks like a duck, and quacks like a duck…then it is a duck.” read more »

  • Competitive Bidding Round 2019
    February 06, 2017

    AMARILLO, TX - On January 31, 2017, CMS announced plans to consolidate all rounds and areas included in the Competitive Bidding Program (“Program”) into a single round of competition – Round 2019.  After the current Round 1 2017, Round 2 Recompete, and National Mail-Order competitions conclude on December 31, 2018, Round 2019 contracts will become effective on January 1, 2019 through December 31, 2021.  Round 2019 will include 141 CBAs and 11 product categories. read more »

  • Optimize Brightree, Optimize Your Business Illuminates on Day One of Medtrade Spring (Feb 27)
    February 06, 2017

    LAS VEGAS – Medtrade Spring attendees who are looking to get a firm grip on all aspects of their business should consider attending the Optimize Brightree, Optimize Your Business workshop, scheduled for day one (Monday, Feb 27) of Medtrade Spring. The conference portion of Medtrade Spring is set for Feb 27 and 28, while the Expo Floor will be open Feb 28 and March 1. read more »

  • Hospital Loan Closet - Legal Basis to Bill Part B
    January 23, 2017

    AMARILLO, TX - It is a common practice for a DME supplier to enter into a loan closet arrangement with a hospital. This is also known as a "consignment" or "stock and bill" arrangement. In a typical loan closet arrangement, the supplier stores inventory (e.g., canes, walkers, braces) at the hospital. When a patient is about to be discharged, the hospital employee pulls the item from the "closet," gives it to the patient, the patient goes home with the item, and the DME supplier bills Medicare Part B. read more »

  • Exhibitor Spotlight - Prometheus Group Offers Revenue Cycle Solutions and Much More
    January 23, 2017

    LAS VEGAS - Prometheus Group is on a mission to help HME providers prosper in a new era of value-based care. Medtrade Spring attendees looking to streamline their operations will get a chance to meet with the company’s representatives at Booth #1150 when the show floor opens on Feb 28 and March 1. Educational sessions at the Mandalay Bay Convention Center in Las Vegas start one day earlier on Monday, Feb 27. read more »

  • Preference Payments in Bankruptcy and the DME Supplier
    January 16, 2017

    AMARILLO, TX - Fallout from a high-profile bankruptcy case in the DME world provides a lesson for suppliers on the basics of bankruptcy and what you can do to protect your company. Case in point:  the collapse of Florida-based Univita and its August 2015 bankruptcy’s wide ripple effect across the industry. The company operated in multiple states including Florida, Tennessee, California, Minnesota, Indiana and Massachusetts. read more »

  • Baird Bonus - ALJ Backlog - Light at the End of the Tunnel
    January 09, 2017

    AMARILLO, TX - The current administrative appeals process is beyond unfair to DME suppliers. A supplier will get hit with a post-payment audit involving multiple patients. The auditing contractor will look for reasons to deny the claims and seek recoupment. The contractor will send a recoupment letter to the supplier.....and then the administrative appeals process begins. read more »

  • Consignment Arrangement with Hospital - Key Contract Provisions
    January 02, 2017

    AMARILLO, TX - It is common for a DME supplier to enter into a consignment arrangement with a hospital. This is also referred to as a "loan closet" or "stock and bill" arrangement. read more »