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

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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