No medical supply ever publicizes their billing numbers; however, I want to let everyone know what the team at Howard’s is up to. According to CMS standards, on the first round of audits for Medicare, the average durable medical supply has 85% of their claims denied by Medicare when they are audited. Now, there are four rounds of appeals, so even though this means only 15% of claims are paid on average in the first round of appeals, it gives you an idea the number of claims Medicare denies that comes across their books.
Last week, Howard’s Medical received our numbers for the last forty-five days. We are running at a 25% denial rate for our Medicare claims, a full 60% better than industry average!
How do we do it?
We communicate with your providers and know the rules for billing equipment inside and out in regards to medical supplies. Just as you want your accountant to know the tax rules inside and out, we know medical supply rules inside and out.
We have an amazing team. They take the time to verify your eligibility, work with you when you are in the store, ask the right questions so when we bill your claims everything goes through and it gets paid.
We also know when an item is not going to be covered. For example when a patient is in a nursing home or hospice, Medicare does not cover most medical equipment.
One other question you might wonder, a 25% denial rate still seems high. You are right, it is. A few other thoughts on this:
There are multiple rounds on the appeals processes when we bill claims. The 75% success rate for Howard’s is just for round one. If we have one of your claims and we fail in round one, we look to see why we failed, verify the reason and sometimes it is a very simple reprocessing of the claim. Other times we have to contact your provider and ask for addendums to chart notes. Worst case scenarios we do have to pick up equipment.
Other insurances for the most part are significantly easier to bill than Medicare. So if you don’t have Medicare take heart, life is much easier for the billing side of things for your medical supply company.
Medicare is slowly working on things. There are a number of bills in congress working to streamline things. Please contact your senator and congressperson and ask them to ease up on the audits. We are not anti-audits because they prevent fraud but in high school if you get 99 out of 100 on a test this is an A+. With a Medicare audit, a 99 out a 100 is a failure that has to be fixed!
If you have any durable medical or respiratory billing questions, give the team at Howard’s a call, we really do know what we are talking about and have the numbers to back it up: 509-654-9899.
It’s that time of year again. Our semi-annual trade show in Vegas where all the business leaders who run medical supplies gather in Las Vegas to network and look at the newest products. I want to share some of my insights from the trip.
I always like seeing new products. Three of my favorites:
Evolution walkers: We have carried these for over a year now. These are the BEST walkers on the market and they are priced this way too. For the person who doesn’t want to deal with the generic Medicare walker and has the money to spend, this is the way to go. We call them European walkers because those in Europe know how to get around and appreciate walking. We have three different kinds of these walkers at our store so try both the Medicare walker and this one out and you’ll see what we are talking about!
Sunrise Medical who handles all of our lightweight wheelchair products has a new no-insurance wheelchair. Howard’s is the exclusive dealer here in Yakima. Some of the neat things you get in this chair: easily adjustable push handles (which is great for someone like me who is 6’2” tall), brakes on the handles instead of having to bend down and set them on the wheels, and disc brakes. All of the other qualities of a lightweight wheelchairs are still there including quick release axils but they took a good wheelchair and made it great!
How does someone who is a quad supposed to easily pull their pants up in the bathroom? There is a product now for this individual called pants-up-easy. This is a product we can order for these individual because they deserve to be independent just like the rest of us!
I hate talking about this, but most of our business is contingent on what is going on in Washington DC. In January of 2016, Medicare is planning on making rural areas accept the larger city’s reimbursements. What this really means for the residents of the Yakima Valley is we will be reimbursed less for our medical products. For example instead of being reimbursed $182/month for oxygen, this will drop to close to $100. Instead of $140 for a walker with seat, this will drop to $85. It doesn’t take a rocket-scientist to know you won’t get the same quality product.
Howard’s recently joined AA Homecare to help in the lobbying effort to make this so it doesn’t happen. If it does go though we will be okay as business; however, Howard’s will have to become even more efficient and handle more with less. What this means for our customers is we frequently have to provide a more affordable options instead of what we currently offer. Yesterday as an example, we had a patient who needed help and adjustments on a product in Mabton, we made the trip. These trips will be harder to make if Medicare forces us to do more with less and those patients will have to come to our store instead of us going to them.
Last and my favorite part of MedTrade was the networking. There are not many of us here in Yakima who run a medical supply store. I had a great opportunity to go to dinner with another family owned DME out of Wenatchee and another out of Oregon. We shared some of our secrets about taking care of our customers, winning audits, and what we can do to become even better at our trade (what we call our Ninja secrets here at Howard’s).
One of the first things everyone should do in the new year is spend five minutes calling their insurance asking what the requirements are for any of your prescription medications, verifying that your pharmacy, doctors, and durable medical equipment providers such as Howard’s are in-network and going over your current year deductibles so you can plan your cash flow. Taking these five minutes at the beginning of the year can spare yourselves hours and sometimes hundreds of dollars in out-of-network charges.
In 2015 the Medicare deductible is $147.00. Other insurances have different deductibles and you need to be aware of where your requirements are. With the Affordable Care Act, we have seen deductibles as high as $12,000 for a family plan. This means that an individual must pay out-of-pocket expenses of $12,000 before any insurance kicks in if you fall into this category.
One more thing is just because you have a deductible, the regular insurance requirements for an item (valid prescription and justifying chart notes) usually need to accompany the order. As an example, you need PAP supplies such as a mask, headgear and tubing, when you come to Howard’s you will still need a valid prescription before picking up these items. Some insurances also require a valid sleep study as well! If you are confused or have any questions, give our store a call and we will walk you through the process. One of the advantages of doing business locally in the Yakima Valley is we are here to help you and walk you through the process. We are here to call your doctor’s office for you to help you get the right paperwork so you can get the supplies you need to have a healthy and happy year.
Happy New Year from Howard’s Medical where we are looking forward to having our family serve your family’s healthcare needs in 2015.
Yakima medical supplies. CPAP, Oxygen and Wheelchairs