Planning for audits reduces the threat of fines. (From left) Sam Robinson, Eric Parkhill, and Chris Kennedy of Home Medical Professionals work with billing expert Jane W. Bunch, RT, to keep their business fine-free.

I was just tall enough to see over the pharmacy counter when I began assisting my daddy in putting labels on prescription bottles for my family’s independent South Georgia pharmacy. After 32 years, my family still operates this pharmacy along with seven HME companies, but now I am out on my own, using the knowledge gained from 20 years in the health care industry to run the billing and consulting company I founded.

One of the privileges of being in this profession is working with companies that got into home health care for the same reasons I did. I became a respiratory therapist because I loved taking care of the needs of the patients served by my family’s HME companies. To walk in and see the face of a patient who looks forward to seeing you every month is worth all of the heartache and headaches that reimbursement regulations may cause you. Likewise, my clients Eric Parkhill, Sam Robinson, and Chris Kennedy of Home Medical Professionals in Gainesville, Ga, also got into home health care because of a love of helping others.

I have been the consultant for Home Medical Professionals since the day this independent provider opened its doors, and I especially enjoy billing and consulting for this client because they are a model of how to do things the right way. Parkhill, Robinson, and Kennedy have made every attempt to meet compliance guidelines with Medicare, Medicaid, and other third-party payors.

This is not an easy task. With the daily growth and changes that face our industry, it is difficult to stay current and to educate yourself in operating an HME company. But Home Medical Professionals has succeeded in staying educated and compliant while continuing to grow.

Clean as a Whistle
Home Medical Professionals faces the same challenges, routine audits, and daily operations that all other independent providers face. But they differ from many of my clients in that they try so hard to ensure everything is correct and compliant.

The company just faced a routine audit and I represented it in this audit from day one. When we were done, the auditor’s comments said simply, “The audit has been completed. We could not find one thing to fine you on, and as we see it, you actually give away a lot to patients that you never were paid for due to excessive use of the patients’ over-allowable amounts.”

Few companies come out of audits not paying back fines because providers generally believe it is unimportant to have an experienced consultant and billing company. They think they can just call one when they are audited.

Be proactive. Prepare for an audit before it ever happens and you may have the same results as Parkhill, Robinson, and Kennedy did instead of a half-million-dollar overpayment or more.

Education is the Answer
Reimbursement issues have changed drastically over the years. I remember when the Medicare manual was very thin and there were few guidelines to follow with documentation and paperwork. Now, my Medicare manual takes two 3-inch binders and the advisories and updates another binder.

Every provider should understand the importance of having a Medicare manual in the office, at each billing desk, and at the intake desk. If we fail to properly educate our employees, what should we truly expect from them?

Home Medical Professionals spends time and money to educate employees and referral sources to better service patients. Parkhill, Robinson, and Kennedy send their staff to billing seminars to ensure every employee is comfortable with his or her job duties. This has been a huge asset to the growth that their company has experienced, but not all providers realize how resources spent on education pay off later.

One of the main problems I face with clients is their lack of staff training. Your employees may be the first impression of your company that your referral sources will get. But many companies still hire an intake coordinator and simply give them a form to complete when the telephone rings. This person begins to take the order neither understanding what questions to ask, nor the equipment or supplies for the order.

Do not let this happen in your company. Take your intake coordinators to the warehouse and teach them about the equipment, what supplies are needed with the equipment, and for what purpose the equipment is used. They must be taught the same documentation and qualification for equipment/supplies as the billing department.

The time taken to train will come back to you threefold. Just ask Parkhill, Robinson, and Kennedy. They train properly from the initial intake process, decreasing delays in reimbursement and decreasing their days sales outstanding (DSO) in the process.

How to Train
Have you ever tested your employees? If not, are you certain that they have the knowledge to fulfill the requirements of the job they have been hired to do? You need to let your employees know what you expect of them and that you, the owner, will be learning the billing requirements yourself to better audit your staff. Parkhill, Robinson, and Kennedy are very active in the daily operations of their business. They come to educational seminars, they take the same tests I give their employees, and they learn about the reimbursement issues and documentation requirements.

Testing can also help ensure employees do not put off reading Medicare advisories and updates. Each time a Medicare update or advisory arrives in the mail or is printed from a Durable Medical Equipment Regional Carrier (DMERC) Web site, make copies and hand them out to your staff. After giving your staff a few days to read the updates, test them on the material.

In my company, I like to train new employees from the very beginning. This way I know they are learning correctly and efficiently. They begin with data entry and are tested in this area before they can go any further in the company.

When they score a 95% or above on this test, they obtain a certificate and are placed in the department of our choosing. There they are given written materials to study and assigned one piece of equipment or category of equipment to learn. Their supervisor audits their work and when the supervisor believes an employee is ready, the employee is tested on the documentation, qualifications, paperwork, and legalities of billing for the piece or category of equipment that he or she was assigned to learn.

When employees score a 95% or above on the equipment test, they may begin supervised billing. The supervisor checks the employee’s work regularly, ensuring that it is accurate and efficient. This ensures that the employees learn what is required and gives them the confidence of knowing they are doing the job correctly.

Audits Add Up
Reimbursement is big business. The DMERCs recoup millions of dollars from providers each year in postpayment audits. At times, the recoupments are based on rules that they were unaware of or interpreted differently from the DMERC. Few providers I have visited intended to commit fraud. Instead, they made billing errors or lacked documentation based on what they were able to obtain from the physician or referral source.

Providers win 80% of overpayment cases on appeal, but that is little comfort because the law requires that you pay back any overpayments and fines before the decision can be appealed. I had one client whose total overpayment equaled $532,000. If you are an independent HME company, a half-million-dollar overpayment can put you out of business. And even if you win your appeal, you must wait for your money to be returned, and it is usually repaid without interest.

The four DMERCs, the state Medicaid programs, and the federal insurance companies may audit you at any time. Take the time to discover the problems you may have in your documentation so you can fix the errors before you are audited.

Now is not the time to sell your company. Now is the time to acquire smaller companies that cannot stay in the industry for various reasons or grow your company in your current location or open additional locations. I believe that, with the population of beneficiaries calculated out in the next 10 years, our industry will be one of the fastest-growing in the nation.

You are blessed to be in this industry. Feel blessed. Remember why you opened the doors of your HME or pharmacy and ask yourself if you still have that same feeling. I and my clients at Home Medical Professionals have as much love for this industry now as we did when we got into this business. Fight for our industry and keep up with the laws being passed that affect you directly or indirectly.

Jane W. Bunch, RT, is CEO and founder of JB&CS Inc, Marietta, Ga. A proud mom to Bianna, 5, and Robert, 17, she travels extensively to consult for HME companies and writes and speaks frequently on billing and reimbursement issues. Contact JB&CS Inc at (678) 445-1221.