HOW TO MAKE MONEY ON DME AND COMPLY WITH THE NEW REGS

By: Chantelle Walker

New Revenue Stream Provides Easy Access to Significant Profits

The old stock-and-bill model is out the new “physician friendly” model is in.  Gregory Simms, President of DME Advanta, LLC speculates that “the in-office DME trend will increase anywhere from 10-25% in the next five years due to a newly established federal mandate which does away with the old ‘stock and bill’  model.” As an industry veteran with over 20 years experience, Simms pioneered the in-office DME protocol after he continued to see shrinking reimbursements, dwindling patient loads and the need for ancillary services to improve profitability. The new model uses such services to put profits back in the pockets of doctors.

Why DME makes Sense and Money

According to Simms, “Practices such as neurology, orthopedics, pain management and sports medicine can expect profits of $2000-$12,000 per physician, per month based on three criteria: type of specialty, typical DME utilization, and payer mix” Certain products, for instance Bone Growth Stimulators, garner nearly $3500 in revenue per patient. Combined with the frequency with which such a device is used in your office, and expected payment, you can project the annual benefit from handling the service at the point of care. (See a sample pro forma at the end of this article.)

What’s in it for the Patients?

Beyond profits, patients receive the added benefit of ‘one stop shopping’, resulting in improved compliance rates and outcomes. Research has shown that compliance in reases from 20-45% with the establishment of an in-house program. “ Not surprisingly, giving patients the DME they need in the clinic, properly fitted and with complete instructions, ensures better protocol compliance and healing, ” says Simms. Resulting healthcare costs also decline – to the tune of 12-14% – due to greater clinical outcomes, fewer complications and faster recovery times.

How the Billing Works

Billing is a concern for most offices due to the complexities involved. Some companies, including DME Advanta, LLC handle all aspects of billing including: claims to the insurance companies, patient statements if balances are due, and the appeals process. Simms says that billing and reimbursement for DME takes organization and persistence. It requires a very thorough process, providing for calls to payers for claims follow up and subsequent calls after that, if needed. The process would be extraordinarily taxing for individual office staff to handle in addition to their current demands. That’s why the new DME model has removed the burden from offices and placed it in the capable hands of billing experts.

 The Legal Side of DME

It’s very important that the vendor you select can prove they’ve done their homework.  DME Advanta is one program that is fully compliant with both Stark Act and Anti-Kickback Statue. While Stark Laws deal with physician self referral – primarily prohibiting physicians from referring to an entity in which he or she has a vested interest – Anti-Kickback laws prohibit payment for referrals. Failure to comply with either or both laws comes with steep penalties – and ignorance is not a defense in the eyes of the government.  The government not only allows the practice of in-office DME, they encourage it.

Via the Federal Register on January 1, 2001, it was stated that “in the interest of patient convenience, we are using our regulatory authority under section 1877 (b) (4) of the Act to expand the in-office ancillary services exception to include certain DME…In so doing, we are concerned primarily with enabling the patient to depart from the physician’s office with DME products.“  Simms cautions that, in order to minimize risk, clinics must have processes in place; including a compliant resolution protocol, patient agreements and product failure forms.

Getting Started

If your specialty is Orthopedic, Neurosurgical/Neurology,  Pain Management, Chiropractic, Physical Therapy, Podiatry or Rehabilitation, chances are you would benefit from providing your patients DME at the point of care. Getting started  requires a brief survey with questions related to payer mix, procedures performed and the products used. The survey helps to generate a free, but individualized, financial proforma to help you determine if this model is right for you.

Contact the Healthcare Networks of America Physician Services Division to determine if this or other revenue programs are suitable for your practice at 877-311-3338

1 Pain Management Doctor-Sample DME Financial ProForma-September 9 2009 (2)

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