Moving the HME Industry Forward

Billing/Reimbursement

Success with Traditional Payors

July 31, 2017

ATLANTA – Much has been made of the caretailing phenomenon throughout the HME world, but plenty of providers still rely on traditional payors such as Medicare and third party insurance. When Medtrade convenes from Oct 23-25, 2017, in Atlanta, wisdom will be in high supply during a variety of informative educational sessions.

Sarah Hanna, CEO of ECS North, Tiffin, Ohio, is a veteran presence at Medtrade, and she will be back with other experts to share best practices and techniques for success. A conversation with Hanna sheds light on what Medtrade attendees can expect to find at the fall version of the nation’s premiere HME-focused event.  

Medtrade Monday: How difficult is it these days for providers to make a living via traditional payors such as Medicare and third party insurance?
Sarah Hanna, CEO, ECS North, Tiffin, Ohio: As everyone knows, shrinking reimbursements have had a significant impact on providers. Not only has Medicare taken on lower fee schedules but that same decrease has been adopted by third party payers as well.

Some third party payers had negotiated percentages of the Medicare fee schedules, such as 75%, with providers back when the fee schedule was higher. When the Medicare fee schedule started to drop, the percentage carried over which was even more unsustainable than the Medicare reimbursement levels.

Medtrade Monday: How can providers deal with this?
Hanna: Providers must fight to collect on every viable balance to stay afloat. This means that all processes must be streamlined and efficient through their organization to maximize every potential payment.

Medtrade Monday: What types of challenges have you been seeing among clients who come to you for consulting/advice?
Hanna: One of the biggest challenges we see when consulting with clients is the knowledge base of staff. Many errors and waste within an organization comes from a team who isn’t trained properly. The lack of focus on training and auditing of the staff’s abilities lead to denials causing missed payment opportunities and increased cost to the company. This issue is a problem for large and small companies alike.

Medtrade Monday: What are the consequences of incomplete training?
Hanna: Lack of training causes process workflows to be full of duplication and costly procedures trying to limit mistakes. Another challenge we see across the provider base is that technology is not being used to its fullest potential due to lack of training, not understanding updates, and lack of legacy knowledge.

Medtrade Monday: What are the misconceptions about proper billing/documentation?
Hanna: A common misconception is that since Medicare Advantage payers haven’t audited providers in the past, they’re not going to start. A lot of Medicare Advantage payers have been wising up to Medicare requirements and are really starting to enforce them. If they have always stated that they follow Medicare requirements, then providers need to evaluate their documentation practices and risk exposure in the event that they start to audit. Also, Medicare Advantage plans may not always implement Medicare requirements properly, which lead to incorrect denials. Providers must hold them accountable when they are improperly processing claims.

Medtrade Monday: Why should people still make the effort to come to trade shows such as Medtrade?
Hanna: Medtrade has really listened to attendees over the years and has reinvented the conference to reflect what providers have requested—a more interactive experience. The presentations are made up of panels and provide opportunities for open discussion among speakers and attendees. This means that networking is at a premium. You can connect with providers, panelists, and industry experts easily—you just have to take advantage of the opportunities. Medtrade is an invaluable experience.  

Find Sarah Hanna at Medtrade
Survive and Thrive in the Constantly Changing World of Medicare Audits & Compliance
Tuesday, Oct 24, 2017: 4:00 PM – 5:30 PM
Plus:
• Denise Leard, attorney, Brown & Fortunato
• Josh Britten, general manager, Britkare Home Medical LLC

Strategic Management: A Discussion on How to Plan for your Company’s Future
Wednesday, October 25, 2017: 1:30 PM – 3:00 PM
Plus:
• Erik Mikelson, CEO, Howard’s Medical LLC
Gary Sheehan, president and CEO, Cape Medical Supply Inc
John Reed, executive vice president and co-founder, Central Ohio Specialty Care