In April 2019, the government  indicted 24 defendants which included owners of dozens of DME companies and  issued administrative actions against 130 orthotic suppliers who had been utilizing telehealth visits to obtain orders for braces.  The government quickly took action against these companies and individuals. However, that was only the beginning.  As a result of the initial steps taken in Operation Brace Yourself, the government has expanded the scope of its investigation and additional actions are being taken against suppliers who were engaged in the provision of orthotics. This presentation will discuss areas of concern raised by the government in the provision of orthotic braces and will walk the attendee through the investigation process. It will also discuss pitfalls in marketing arrangements and telehealth visits for braces.  

Out With the Old and In with the New. This last year has been one for the record books with more DME suppliers facing more challenges than ever before.  All of this and a regulatory landscape full of mines can feel overwhelming at times but knowing how to face these challenges head on will be important for a supplier to thrive and flourish.  There are many hot button issues that suppliers will be facing in 2021. This program will address these including (i) the dos and don’ts of marketing (ii) how to properly build a referral network; (iii) consignment arrangements with hospitals; (iv) assisting hospital in preventing re-admissions; (v) selling Medicare-covered items at a discount off the Medicare allowable; (vi) avoiding problems with the NSC, UPICS and other Medicare contractors and (vii) providing DME on a non-assigned basis.

The Key to Working with Physicians is Understanding the new STARK Law Guidance: Physician relationships are key to succeeding in today’s competitive environment and DME suppliers that work on building those relationships will flourish.  Unfortunately because the government has chosen to regulate the healthcare industry this means that what is allowed in other industries may not be allowed in healthcare.  The STARK Law is one of those regulations that changes the rules.  The STARK law was put in place to prohibit over utilization by physicians be creating limits to a physician’s ability to refer to an entity in which the physician has a financial relationship. As a result, anytime a supplier has a financial relationship with a physician, the supplier must analyze its activities for compliance with STARK. STARK was first enacted in 1989 and over time the reimbursement models have evolved from almost exclusively fee for service to a value based models.  CMS has recently issued new guidance and exceptions to STARK that address value based compensation models.  This program will discuss recently published STARK guidance that applies to relationships between suppliers and  physicians.  Understanding this new guidance will be important to working with physicians as suppliers develop these key relationships.

Maintaining your continuing education requirements for compliance, licensure, and accreditation has never been easier. Join us to learn more about our state-of-the-art learning management system: HealthTrainU. We have over 200 courses in more than 20 different content libraries written for and by providers. This webinar will walk you through the platform and explain how you can start a free trial.

“Leave it to Beaver” has been replaced by “Modern Family.” The old way of running a DME business no longer works. With competitive bidding, stringent documentation requirements, lower reimbursement, and post-payment audits, Medicare fee-for-service should only be a component of the supplier’s total income stream. There are 78 million Baby Boomers retiring at the rate of 10,000 per day. Boomers are accustomed to paying for products out-of-pocket. And most Boomers want the “Cadillac” product - not the “Cavalier” product - so they can have an active lifestyle well into their 80s. The successful DME supplier will be focused on selling upgrades, utilizing ABNs, and selling “Cadillac” items for cash. These retail sales may take place in a store setting, through a kiosk, or over the Internet. When selling products for cash, there are a number of requirements that the DME supplier must meet. This program will discuss these requirements. Lastly, this program will discuss the benefits of setting up a separate legal entity through which the retail business will be operated.

The health care industry is one of the most regulated industries in America.  The anti-kickback statute and other guidance affect how a supplier can market and build relationships with those that can refer business. This presentation will discuss key statutes and regulatory guidance that must be considered when marketing to referral sources.  

Some billing activities seem pretty straightforward, but the devil is in the details.  This presentation will discuss common billing documentation issues such as how to properly use an Advance Beneficiary Notice, assignment of benefits, billing assigned vs. non-assigned, delivery documentation, and co-payments and deductibles to name a few. Understanding the rules in these common scenarios can reduce documentation errors.  Reduced documentation errors means the supplier will keep its hard-earned money.  

In today’s competitive environment, customers are hard to win and keep. In addition to providing quality products, suppliers must provide excellent customer service above and beyond what their competitors are providing. In doing so, suppliers must be careful to not violate any regulatory guidelines. This presentation will discuss the regulatory guidance that suppliers must consider when going above and beyond for their patients. 

Technology is continually changing our everyday lives and the health care industry is no exception.  However, the health care industry is highly regulated.  Therefore, if you are going to utilize telehealth in your business, you must understand the rules. This presentation will cover topics such as when it’s appropriate to bill for telehealth visits, billing for these visits, potential kickback issues, and much more.  Learn how to recognize proper and improper telehealth arrangements and integrate proper telehealth arrangements into your business. 

It's that time of year again (and not just for the kids)...Back to School. Join us to learn more about HealthTrainU and how this learning management system can help you better organize your continuing education efforts. This platform allows its users to easily track credits, generate reports, take tests, and more. These features are imperative when it comes to maintaining your continuing education for compliance, licensure, and accreditation. At the end of the webinar, stay on for a Q&A session and how you can start a FREE trial!

The Do’s and Don’ts for Suppliers Responding to State Medicaid Audits and Investigations - With the expansion of Medicaid, more individuals than ever are covered under Medicaid programs.  Additionally, there is a large shift to greater utilization of Medicaid Advantage programs. This means that suppliers have more rules than ever to follow and with more rules comes greater scrutiny of suppliers.  Medicaid agencies across the nation have stepped up their enforcement activities with audits and investigations.  As a result, more suppliers are facing Medicaid investigations than ever before.  How well or poorly a supplier responds to an audit as well as how the supplier chooses to address an investigation will make all the difference in the world in the outcome.  This presentation will highlight the increased audit activity around the country, address enforcement activities that might involve your company, and provide tips for properly responding to audits and investigations in this era of increased scrutiny.    

While a marketing company may be very good at securing leads, unless the marketing company also understands health care regulatory laws, buying  these leads could mean trouble.  The health care industry is highly regulated and many activities that are perfectly legal in other industries could be subject to criminal penalties.  There are certain rules that a DME supplier must understand when buying and utilizing leads.  This presentation will cover  these rules and include a discussion of how to pay for and use marketing leads within regulatory guidelines. Knowing how to structure marketing arrangements and how to contact the leads acquired can keep a supplier out of trouble.  

Learn more about this incredible learning management system to help you maintain your education requirements. HealthTrainU makes it easy for employers and students to maintain their education including classes, tests, records, and more. Best of all, HealthTrainU is offering a free trial to give you a chance to test it out. Join us to learn more and how to get started!

Technology has made the exchange of information easier than ever.  But that ease comes with a price.  HIPAA was put in place to ensure that health care providers who maintain protected health information (PHI) take steps to protect the PHI in its possession from unauthorized use.  Failure to do so can result in significant fines and penalties.  Despite a covered entity’s best efforts, unauthorized disclosures do happen—opening Pandora’s box.  Once Pandora’s box is open, a covered entity must immediately take steps to mitigate the damage.  This webinar will discuss proactive steps that can be taken to prevent a breach, and in the event of a breach, what must be done to comply with HIPAA.

The good news is Medicare pays quickly.  The bad news is that Medicare is also quick to take action against suppliers that it feels are not compliant.  Any time a supplier finds itself dealing with an adverse action, the life of the company is on the line.  Responding quickly and appropriately may be the only way for the company to survive, but many suppliers don’t know what to do in such situations.  Suppliers need to always be vigilant in preventing adverse actions; but if it finds itself dealing with one, it needs to have a plan for responding.  This webinar will discuss adverse actions such as PTAN revocations and payment suspensions along with strategies to respond to these adverse actions.

As a DMEPOS provider, you have plenty on your plate. Ensuring compliance, preparing for accreditation, maintaining licensure, and all the other tasks you’re charged with can be tough to handle. Then add in your education requirements for all of that and it’s downright overwhelming. Luckily, HealthTrainU™ is here to take some of the pressure off! Join us to learn more about this learning management system and how it can help you, your organization, and your employees.

CBD or Cannabidiol is extracted from hemp plants and has been touted as a cure for everything from minor aches and pains to being able to treat patients with diseases such as multiple sclerosis, Parkinson’s disease, and many others.  The passage of the federal Farm Bill, which allows for cultivation of hemp, has created increased interest in CBD and products containing CBD.  However, the legalities of CBD are not as straight forward as most people believe.  This webinar will discuss the laws and regulations that suppliers should understand before deciding to add CBD to the products it offers.

The DME industry is in a transition period.  Competitive bidding is in transition and a new round will be implemented in January of 2021.  Margins are thin and reimbursement continues to decline.  Suppliers are being hit with audits, and many are facing targeted probe and educate (TPE) audits.  Increasingly, Medicare and Medicaid patients are moving to managed care plans.  And yet, with the aging of 78 million baby boomers, the demand for DME is increasing.  In order to succeed, the DME supplier needs to implement “economies of scale” that allow it to serve patients in a cost-effective manner.  This webinar will discuss specific examples of ways that suppliers can streamline their operations.  For example, the webinar will discuss centralized intake in which a supplier with multiple PTANs can have only one intake office.  The webinar will also discuss the “hub and spoke” model that allows a supplier to expand geographically without having to go through the expense of obtaining additional PTANs.  Increasingly, in order to reduce expenses, suppliers are utilizing offshore contractors.  The webinar will discuss the requirements the supplier must meet in order to work with such contractors.  These and other examples will be discussed that are designed to allow the supplier to provide quality services and products in a cost-efficient manner.

Before Section 6402 of the Affordable Care Act (ACA) and subsequent regulations, if a DME supplier discovered that some of its past claims should not have been paid because of documentation deficiencies and/or other reasons, it was not uncommon for the supplier to fix the problem from a “go forward” standpoint and not worry about what happened in the past.  However, after the ACA, that is no longer an option.  In accordance with ACA, if any provider or supplier becomes aware of an overpayment (or should have become aware of an overpayment), it has six months to investigate and quantify the overpayment.  Thereafter, the supplier has 60 days to repay the overpayment.  Failure to do so may result in civil monetary penalties under the federal False Claims Act.  This program will discuss the “60-Day Rule” and the obligations it places on suppliers.  In particular, the program will discuss the six-year lookback period and what “should have become aware” means.  Lastly, the program will discuss how a supplier can properly investigate and quantify past claims that should never have been paid.

As a DMEPOS provider, you have plenty on your plate. Ensuring compliance, preparing for accreditation, maintaining licensure, and all the other tasks you’re charged with can be tough to handle. Then add in your education requirements for all of that and it’s downright overwhelming. Luckily, HealthTrainU™ is here to take some of the pressure off! Join us to learn more about this learning management system and how it can help you, your organization, and your employees.

Oxygen is essential to human life.  For DME suppliers that provide oxygen, it is one of the more complicated areas to provide service.  The qualifying criteria is dependent on multiple things including oxygen saturations and whether or not the patient was in a chronic stable state.  While this may seem straightforward, it is not always as clear as you would think.  Oxygen is one of the few pieces of equipment that still requires a Certificate of Medical Necessity, and complying with the local coverage determination documentation requirements can be tricky if you do not pay careful attention.  In addition, Medicare will only reimburse a supplier for 36 months; but then the supplier is obligated to service the beneficiary’s oxygen needs, for very little compensation, for the next 24 months unless the 36-month rental period can be restarted.  All these rules and exceptions can be confusing.  This program will address issues such as oxygen coverage criteria, when a 36-month period may be restarted, and oxygen documentation requirements suppliers face in the provision of oxygen equipment.

Awareness about obstructive sleep apnea today is similar to awareness of diabetes 20 years ago.  Most physicians (not just pulmonologists) are aware that OSA leads to many health problems.  The opportunity for the DME supplier is to be able to sell the CPAP to the patient as well as the supplies (mask, tubing, and filter) on a regular basis thereafter.  In the past, testing for OSA occurred primarily in “brick and mortar” sleep labs where the patient would spend the night.  Over the last several years, testing for OSA has increasingly shifted to home sleep testing.  This is more cost effective and patient friendly.  Recognizing that abuse can occur if the DME supplier has any connection with the HST, CMS has essentially said that a CPAP supplier can have nothing to do with a HST.  As to whether commercial insurers impose similar restrictions is on an insurer-by-insurer bases.  This program will discuss the restrictions that CMS has placed on DME suppliers, the consequences if the supplier does not adhere to the restrictions, and the type of relationship that the DME supplier can have with the HST entity.  Lastly, this program will discus whether the restrictions apply to a CPAP supplier that is owned by a hospital that also conducts the HSTs.

When a person intends to buy … or sell … a DME supplier, there are a number of documentation and regulatory issues that must be addressed.  First, the seller must take a number of steps to make itself more “attractive.”  The buyer and seller need to decide whether the transaction will be an “asset” sale or a “stock” sale.  The parties will need to engage in the normal transaction steps: mutual nondisclosure agreement, letter of intent, stock purchase agreement/asset purchase agreement, and other closing documents.  The buyer will need to engage in three types of due diligence: financial, corporate and regulatory.  And the parties will need to meet a number of regulatory requirements such as submitting change of ownership notifications.  This program will discuss all of these (and other) issues associated with the purchase and sale of a supplier. 

The DME industry today is a totally different animal from yesterday.  The industry has matured, technology has progressed, and demand is increasing exponentially.  The flip side is that the industry has been hit with breathtaking legislative and regulatory changes.  Now more than ever, in order to succeed, the supplier must have an innovative marketing program and enter into strategic joint ventures and business arrangements.  This webinar will discuss the legal parameters that must be followed when implementing a marketing program and entering into joint ventures and arrangements with referral sources.  Among other issues, this webinar will discuss the Medicare anti-kickback statute, the Stark physician self-referral statute, the beneficiary inducement statute, the telephone solicitation statute, safe harbors, and OIG fraud alerts.

The OIG has stressed the importance of compliance programs for DME suppliers by issuing guidance on how the programs should be structured and implemented.  Congress has also weighed in through the Affordable Care Act which makes compliance programs mandatory for DME suppliers at a date to be set in the future.  This webinar will discuss how an effective compliance program helps create financial success, customer loyalty, community support, and employee satisfaction.  Topics covered will include primary compliance program objectives, the role of management in overcoming implementation obstacles, and identifying and addressing risk areas.  Topics will further include changing behaviors, balancing multiple roles, integration with other parts of the organization, education and training, and finding qualified staff.  The program will review the elements of an effective compliance program and the need to regularly review and update the program.  Specific risk areas arising from marketing of DME will be discussed as well as how to identify and address risk areas particular to DME suppliers.

DME suppliers always seem to be caught in a perfect storm of business and regulatory changes and must be prepared to respond. This webinar will discuss the hot-button business and regulatory challenges that DME suppliers face, which includes increased aggressiveness of CMS contractors such as UPICs and preparing for and responding to pre-payment and post-payment audits including Targeted Probe and Educate audits among other topics. Attendees will learn about and be able to respond to these challenges while recognizing opportunities to thrive in today’s turbulent environment.

An Industry in Transition: Hot Button Issues for DME Suppliers

The DME industry is young and it grew up unregulated. However, over the past 10 years it is as if CMS and Capitol Hill are making up for lost time. The industry is now caught in a "perfect storm" of competitive bidding, lower reimbursement, out-of-control audits, and stringent documentation requirements. In short, there are many "hot button" issues facing suppliers. This program will address these issues, including 
(i) Dos and don'ts of marketing 
(ii) How to properly build a referral network 
(iii) Consignment arrangements with hospital ERs 
(iv) Assisting hospitals in preventing readmissions 
(v) Selling Medicare-covered items at a discount off the Medicare allowable 
(vi) Avoiding problems with the NSC, ZPICs and other Medicare contractors 
(vii) Providing DME on a non-assigned basis.

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Competitive Bidding contracts ended on December 31^st leaving suppliers the opportunity to provide competitive bid products until the next round starts. CMS recently announced that the next round would start January , 2021 with the bid window opening in June.  This program will discuss the latest available information on Round 2021 including steps to take in order to prepare for a successful bid submission.  For example, Round 2021 requires suppliers to obtain a surety bond for all competitive bid areas in which the supplier wants to bid.  It will also cover licensure, accreditation and financial requirements so a supplier will understand what steps it must take now in order for a successful bid.  This program will also discuss opportunities  and challenges suppliers will face during the gap period which allows any willing provider to provide products.

1. The attendee will be able to discuss the implementation of the next round of competitive bidding, Round 2021.
2. The attendee will understand what steps it should begin taking to submit a bid packet for the next round.
3. The attendee will be able to discuss reimbursement policy for products supplied during the gap period.

This webinar will focus on: 

· Understanding what to measure and how to apply
· Distributing information for maximum effect
· Meeting regulatory requirements in a busy world

Innovative Marketing and Arrangements with Referral Sources

• Federal anti-kickback statute
• The Stark physician self-referral statute
• The beneficiary inducement statute

What to Expect When An Audit is No Long Routine

In today’s environment, it is not a question of if a supplier will be audited but when a supplier will be audited. The goal is to minimize the effects of the audit. Knowing what to expect and knowing what tools are available to CMS can make a very difficult situation less challenging. This program will walk attendees through a fact scenario and points out pitfalls and proactive steps that can be taken to avoid getting caught in a trap.

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HIPAA Marketing Guidelines: How to Avoid Legal Traps

In implementing a marketing program, the DME supplier normally focuses on the standard anti-fraud guidelines set out in the Medicare anti-kickback statute, the Stark physician self-referral statute, the beneficiary inducement statute, the telephone solicitation statute, and other anti-fraud statutes and regulations. Equally as important as the standard anti-fraud guidelines are the HIPAA marketing guidelines. Whether the customer is covered by Medicare, or commercial insurance, HIPAA sets how a DME supplier can and cannot disclose and/or use “protected health information” of a customer or prospective customer. This program will discuss the HIPAA marketing guidelines, what the DME supplier must do to comply with the guidelines and the consequences to the supplier if it fails to comply with the guidelines.

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The Valuable Employee: Steps the DME Supplier Can Take to Prevent the Employee from Leaving and Competing 

This program will discuss:

• The “nuts and bolts” steps that a DME supplier can take to lock a new employee and even an existing employee into a noncompetition/nondisclosure agreement. Certain rules must be followed in order for such an agreement to be legally binding.
• The steps that the supplier can take in the event that an employee leaves and starts competing in violation of his noncompetition/nondisclosure agreement.
• When a noncompetition/nondisclosure agreement is enforceable and when it is at risk of reformation by a judge. Lastly, this program will discuss the steps that the DME supplier can take if a valued employee leaves his employment (with no noncompetition/nondisclosure agreement in place) and starts competing.

Download the slides here.

Buying and Selling a DME Supplier

When a person intends to buy, or sell, a DME supplier, there are a number of documentation and regulatory issues that must be addressed. First, the seller must take a number of steps to make itself more “attractive.” The buyer and seller need to decide whether the transaction will be an “asset” sale or a “stock” sale. The parties will need to engage in the normal transactional steps: mutual nondisclosure agreement, letter of intent, stock purchase agreement/asset purchase agreement, and other closing documents. The buyer will need to engage in three types of due diligence: financial, corporate and regulatory. And the parties will need to meet a number of regulatory requirements such as submitting change of ownership notifications. This program will discuss all of these (and other) issues associated with the purchase and sale of a supplier. 

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W2 Employee vs. 1099 Independent Contractor: Under the Law, There is a Huge Difference

It is perfectly OK for a DME supplier to pay commissions to a W2 employee marketing rep who generates patients for the supplier who are covered by a government healthcare program. On the other hand, if the same marketing rep is a 1099 independent contractor (and not an employee), then the arrangement likely violates the Medicare anti-kickback statute (which is a criminal statute). Why is this? The anti-kickback statute states that it is permissible for a supplier to pay commissions to a bona fide W2 employee (full or part time). The “employee safe harbor” says the same thing. The reasoning behind this is that a supplier is liable for the acts of its employee that are committed in the course and scope of the employee’s duties. The supplier has the obligation to supervise and control an employee, meaning that the supplier is motivated to insure that the employee does not “step over the line” when the employee is marketing to patients and referral sources. Conversely, a supplier is not liable for the acts of a 1099 independent contractor. This program will discuss what elements must be present in order for a marketing rep to be a bona fide employee. The program will further discuss the fact that even though the supplier may call a rep an “employee,” may withhold taxes from the rep’s paycheck, and issue a W2 at the end of the year, that alone is not enough for the rep to be an employee. Under the heading of “substance over form,” the supplier must exercise supervision and control over the marketing rep.

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