For the longest time, the vast majority of questions and concerns from industry shareholders dealt with competitive bidding, but not so much anymore. Now there are basically two concerns.

1) How do you cope with a 9.5% reimbursement cut—especially when the cut will affect some items that are already reimbursed at or below acquisition cost? When compared to other businesses run by independents, our profit margins are some of the lowest in the country. Recent studies show anywhere from 4% to 6% net profit, depending on size of operation.

Peggy Walker & Jerry Keiderling

Rehab providers are already miracle workers. They provide specialized and expensive equipment to those in need, without getting paid for labor, evaluation, setup, training, delivery, client/referral education, or equipment trials. After all this, they must have all the proper documentation to bill CMS, then wait to see if they get paid. I don't know of any other industry that provides all these services and expertise up front, and then must file paperwork in hopes of getting paid a mere fraction of total costs.

Beneficiaries will also suffer from these cuts. All providers will be forced to cut back or eliminate some services. Certain aspects of pick-up, delivery, repair, maintenance, and product line offerings will certainly be targets for reduction. This will ultimately lead to beneficiaries paying more for services and having fewer technology choices. Remember, the proposed 9.5% cut does not take effect until January 2009, so we have some time for rebuttal. It is vitally important for all rehab providers to contact elected officials and convince them that this cut will drastically impact beneficiary access and affect independent providers all over the nation. The complex rehab carve-out from national competitive bidding is evidence that Congress now recognizes complex rehab as a specialty area of DMEPOS, and we need to expand on that while it's still fresh in their minds.

Use common sense tactics to prepare for any possible cuts to reimbursement.

1. Become business savvy and realize we cannot "give" things away.
2. Collect the 20% co-payment.
3. Use the ABN and follow up with results when you get those denials.
4. Pick up the equipment when you get medical necessity denials.
5. Use benchmarking tools and streamline your operations.
6. Do not duplicate paperwork and in-store operations.
7. Look at your systems analysis—inventory control and GPS.
8. Charge for service calls on patient-owned equipment (not covered by insurance).
9. The client is a vital payor source.

2) Fraud and abuse. All of us are getting tremendously tired of being lumped together with a few "clods of dirt" and called criminals. The reason this whole mess started was because CMS allowed fly-by-night operations to receive provider numbers. This set the stage for fraudulent practices and abusive billings for K0011 power chairs. After that, there were changes in the Local Coverage Determination (LCD) with all kinds of "must-dos" for the rehab provider in November 2006. The saga continues with the set and goes. We are in October 2008, and just now we're hearing about post-pay audits in which CMS paid out millions of dollars already, but on what? It was not on complex rehab, but instead K0823s. This is like closing the barn door after all the animals got out.

Those suppliers are closed up and gone, and CMS will never get the money back. Why not stop it up front? Without any serious checks and balances, these same people have/will set up new operations and start putting out K0823s in the same way. They just change their names, move to a different state, and continue to scoot through the system without checks or balances to stop them.

It's time for CMS to police itself. Why are these unscrupulous providers allowed to use supplier-generated forms as medical documentation to get paid? They have the "form" and just bill with a KX modifier without any other files. A quality provider can't do that.

Many physicians and therapists are saying, "I don't document for DME. The other supplier just gives me a form." Or "no one else asks me for all this!" They say this even after repeated educational pieces from CMS have been sent to the professional medical community. This makes no sense at all.

Medicare rulings say CMS cannot force the provider to have the documentation on file, but if there were a post-pay audit, the information would have to be made available. The documentation request would be for clinical documentation from the physicians' chart notes, home health notes, and hospital discharge summaries. It's kind of hard to audit a company that has bilked the system for millions, then closed their doors and moved on before CMS even realizes there might be a problem.

The industry is well aware of the problems that face us, but why can't CMS work with us instead of nitpicking at an area that is vital to truly physically handicapped individuals? CMS must focus on areas of real abuse, and let us take care of our patients the way we have always done and, regardless of the hardships, will continue to do.

The pendulum swings, and it is high time for it to swing back to give us in the DME industry a little relief. We are survivors, and we will survive this inappropriate labeling of our industry—an industry I am proud to be a part of.

Peggy Walker, RN, is a billing and reimbursement advisor for US Rehab, a division of the VGM Group, Waterloo, Iowa. Jerry Keiderling is vice president of US Rehab. Walker can be reached via e-mail: .