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

ZPICs, Accrediting Organizations, and the NSC: How to Avoid Problems
Part Two
This is Part Two of our series about ZPICs, Accrediting Organizations, and the NSC: How to Avoid Problems. This webinar will include a discussion about aggressive activity in the DME industry, steps to reduce cash-flow cutoff, patient protection and the Affordable Care Act, and conduct for the Self-Audit.

ZPICs, Accrediting Organizations, and the NSC: How to Avoid Problems 

Part One

This is Part One of our series about ZPICs, Accrediting Organizations, and the NSC: How to Avoid Problems. This webinar will include a discussion about aggressive activity in the DME industry, steps to reduce cash-flow cutoff, patient protection and the Affordable Care Act, and conduct for the Self-Audit.

Oxygen: Restarting the 36 Months, Pre-Screens, Use of Concentrators, and Other Hot Button Issues

The demand for oxygen is increasing exponentially which creates opportunities for the innovative DME supplier. This program discusses the legal pitfalls to avoid as the supplier serves the oxygen market.
Topics will include:

• When a supplier takes over oxygen patients from another supplier, when can the new supplier re-start the 36-month rental period?
• What constitutes abandonment?
• What happens to oxygen patients when a supplier files for bankruptcy?
• Can a supplier provide free pre-screens to prospective patients? How about to existing patients?
  
• Can a supplier allow a patient to use a concentrator until the patient undergoes an oximetry test?

Download the slides here.

Schemes, Scams, and Flim Flams: How the DME Supplier Can Recognize Fraud Landmines

It would be nice if DME suppliers operated in the “real world" the world inhabited by auto parts stores and widget manufacturers. Unfortunately, suppliers are not in the real world. They are in Alice in Wonderland where “up is down, down is up, and every day they climb through the proverbial rabbit hole.”
In this alternative universe, DME suppliers are subjected to numerous federal and state anti-fraud statutes and regulations. What would be perfectly acceptable in the auto parts world may be a felony in the health care world.
This program will discuss the many anti-fraud statutes and regulations that the DME supplier must follow. More importantly, this program will teach the supplier how to recognize fraud landmines.

Examples of these fraud landmines include:
(i) paying commissions to 1099 independent contractor marketing reps
(ii) routinely waiving co-payments
(iii) violating the telephone solicitation statute and Supplier Standard #11
(iv) furnishing prohibited gifts to physicians and prospective customers

Download the slides here. 

Purchasing Internet Leads: Sure, It Can Be Done, But Be Very Careful

When purchasing Internet leads, it is critical that the DME supplier not violate the Medicare anti-kickback statute. When communicating with leads, it is equally as critical that the supplier not violate the telephone solicitation statute and state and federal “do not call” statutes.

This webinar will inlcude:

• What a contract between a supplier and an Internet lead company should look like
• What the supplier can and cannot do in working with telehealth companies and contacting leads

Download the slides here.

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.

Download 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. 

Download slides here

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.

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.

Download slides here.

Oxygen: When do the 36 Months Start Over?

When a DME supplier provides an oxygen concentrator to a Medicare beneficiary, Medicare will pay the supplier for the first 36 months and then the supplier will be obligated to service the beneficiary’s oxygen needs, for very little compensation, for the next 24 months. Occasions may arise when the beneficiary’s continuous use of the concentrator is interrupted. This interruption may be caused by one of the following:

• The concentrator is lost, stolen, or damaged beyond repair
• There is an extended break in need of greater than 60 days
• The supplier sells its assets to another supplier
• The supplier goes out of business
• The supplier files bankruptcy
• The beneficiary relocates outside the supplier’s service area

When one of these events occurs, and afterwards the beneficiary subsequently starts using a concentrator provided by the initial supplier or a concentrator provided by a new supplier, the question becomes: Can the 36 month rental period start over?

Download the slides here.

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.

Download Slides Here.

Innovative Marketing and Arrangements with Referral Sources

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