| HOW TO MAKE MONEY ON DME AND COMPLY | | | | claims to the insurance companies, patient |
| WITH THE NEW REGS | | | | statements if balances are due, and the appeals |
| | | | | process. Simms says that billing and reimbursement |
| | | | | for DME takes organization and persistence. It |
| New Revenue Stream Provides Easy Access to | | | | requires a very thorough process, providing for calls |
| Significant Profits | | | | to payers for claims follow up and subsequent calls |
| The old stock-and-bill model is out the new | | | | after that, if needed. The process would be |
| “physician friendly” model is in. Gregory | | | | extraordinarily taxing for individual office staff to |
| Simms, President of DME Advanta, LLC speculates | | | | handle in addition to their current demands. |
| that “the in-office DME trend will increase | | | | That’s why the new DME model has removed |
| anywhere from 10-25% in the next five years due | | | | the burden from offices and placed it in the capable |
| to a newly established federal mandate which does | | | | hands of billing experts. |
| away with the old ‘stock and bill’ | | | | The Legal Side of DME |
| model.” As an industry veteran with over 20 | | | | It’s very important that the vendor you select |
| years experience, Simms pioneered the in-office DME | | | | can prove they’ve done their homework. DME |
| protocol after he continued to see shrinking | | | | Advanta is one program that is fully compliant with |
| reimbursements, dwindling patient loads and the need | | | | both Stark Act and Anti-Kickback Statue. While Stark |
| for ancillary services to improve profitability. The new | | | | Laws deal with physician self referral – primarily |
| model uses such services to put profits back in the | | | | prohibiting physicians from referring to an entity in |
| pockets of doctors. | | | | which he or she has a vested interest – |
| Why DME makes Sense and Money | | | | Anti-Kickback laws prohibit payment for referrals. |
| According to Simms, “Practices such as | | | | Failure to comply with either or both laws comes |
| neurology, orthopedics, pain management and sports | | | | with steep penalties – and ignorance is not a |
| medicine can expect profits of $2000-$12,000 per | | | | defense in the eyes of the government. The |
| physician, per month based on three criteria: type of | | | | government not only allows the practice of in-office |
| specialty, typical DME utilization, and payer mix” | | | | DME, they encourage it. |
| Certain products, for instance Bone Growth | | | | Via the Federal Register on January 1, 2001, it was |
| Stimulators, garner nearly $3500 in revenue per | | | | stated that “in the interest of patient |
| patient. Combined with the frequency with which | | | | convenience, we are using our regulatory authority |
| such a device is used in your office, and expected | | | | under section 1877 (b) (4) of the Act to expand the |
| payment, you can project the annual benefit from | | | | in-office ancillary services exception to include certain |
| handling the service at the point of care. (See a | | | | DME…In so doing, we are concerned primarily with |
| sample pro forma at the end of this article.) | | | | enabling the patient to depart from the |
| What’s in it for the Patients? | | | | physician’s office with DME products.“ |
| Beyond profits, patients receive the added benefit of | | | | Simms cautions that, in order to minimize risk, clinics |
| ‘one stop shopping’, resulting in improved | | | | must have processes in place; including a compliant |
| compliance rates and outcomes. Research has shown | | | | resolution protocol, patient agreements and product |
| that compliance in reases from 20-45% with the | | | | failure forms. |
| establishment of an in-house program. “ Not | | | | Getting Started |
| surprisingly, giving patients the DME they need in the | | | | If your specialty is Orthopedic, Neurosurgical |
| clinic, properly fitted and with complete instructions, | | | | Neurology, Pain Management, Chiropractic, Physical |
| ensures better protocol compliance and healing, ” | | | | Therapy, Podiatry or Rehabilitation, chances are you |
| says Simms. Resulting healthcare costs also decline | | | | would benefit from providing your patients DME at |
| – to the tune of 12-14% – due to greater | | | | the point of care. Getting started requires a brief |
| clinical outcomes, fewer complications and faster | | | | survey with questions related to payer mix, |
| recovery times. | | | | procedures performed and the products used. The |
| How the Billing Works | | | | survey helps to generate a free, but individualized, |
| Billing is a concern for most offices due to the | | | | financial proforma to help you determine if this model |
| complexities involved. Some companies, including DME | | | | is right for you. |
| Advanta, LLC handle all aspects of billing including: | | | | |