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:
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?WATCH ON DEMAND
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.WATCH ON DEMAND
The Valuable Employee: Steps the DME Supplier Can Take to Prevent the Employee from Leaving and Competing
This program will discuss:
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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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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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.
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:
DMEPOS Accreditation Renewal
A Peak DMEPOS renewal year is just around the corner! Join us as we show you how to be prepared. Greg Stowell, Education and Consulting Manager for Accreditation University, will cover topics such as, the best ways to utilize Customer Central, performance improvement resources, self audit activities and more!WATCH ON DEMAND
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
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:
Watch Part One of this webinar series for DMEPOS providers. This webinar includes a discussion about competitive bidding, strategies for dealing with industry cuts, a discussion about cash sales, and responding to increased aggressiveness of CMS contractors.WATCH ON DEMAND
Watch Part Two of this webinar series for DMEPOS providers. This webinar includes a discussion about competitive bidding, strategies for dealing with industry cuts, a discussion about cash sales, and responding to increased aggressiveness of CMS contractors.WATCH ON DEMAND