Buyers seeking to acquire durable medical equipment (“DME”) suppliers are not the only ones who perform due diligence – sellers do too. Savvy sellers are now working to determine their leverage in the current market, come up with a realistic asking price, and get a feel for buyers’ suitability before initiating negotiations. This presentation will offer thoughts on preparing for the sale of a DME supplier. Specifically, it will cover: (i) what a buyer looks for in acquiring a DME supplier, (ii) how a DME supplier can make itself more attractive to potential buyers, (iii) how to limit risk and identify issues early in the acquisitions process, and (iv) the key differences between an asset and an equity sale.

Manufacturers and DME suppliers are dependent on each other. It is important to suppliers that manufacturers be able to produce quality products and sell them at a fair price. On the other hand, it is important to manufacturers that suppliers have the ability to purchase and resell the products. It is increasingly common for manufacturers and suppliers to collaborate in order to facilitate the success of both parties. As they work together, manufacturers and DME suppliers need to be careful to avoid violating the federal anti-kickback statute (AKS), beneficiary inducement statute, and related laws. This program will (i) discuss the federal laws that govern manufacturer/DME supplier relationships; (ii) the types of collaboration that are legally acceptable; and (iii) the types of collaboration that cross the line and implicate federal anti-fraud laws. In particular, the program will focus on (i) discounts and rebates in accordance with the discount safe harbor to the AKS; (ii) cooperative marketing arrangements; (iii) sample programs; and (iv) the transmittal of leads from the manufacturer to the supplier.

Who would have guessed that two years later COVID would still be a common topic of conversation and still upending our daily lives. Health care providers are continuing to be affected by COVID more than any other industry, and uncertainty remails. What we do know is that the DME industry will continue to play an integral role in keeping patients in their homes and out of hospitals. We will discuss the opportunities and potential pitfalls that DME suppliers face as they operate in the COVID environment. Other “hot button” issues we will discuss include (i) the aftermath of the Philips recall, (ii) the DME suppliers’ involvement with RPM, (iii) relaxation of the restrictions under the federal anti-kickback statute, Stark, and the beneficiary inducement statute; (iv) collaborative arrangements among DME suppliers, hospitals, and physicians; (v) enforcement of the 60-Day Rule; (vi) relaxation of telehealth restrictions, and (vii) the most recent list of items requiring written orders prior to delivery and prior authorization.

For a respiratory supplier, working with a sleep lab makes sense. But as you know the regulatory guidelines for healthcare providers don’t always follow logic. For this reason, any arrangement between a sleep lab and a supplier must be carefully crafted to ensure compliance. This webinar will examine the legal guidelines that must be followed when structuring such an arrangement and give examples of ways these two types of providers can work together to take care of their patients.

It has been 25 years since HIPAA was signed into law by President Clinton. While HIPAA was designed to improve the efficiency and effectiveness of the health care system, it has resulted in additional work and cost for providers. One would think that after 25 years, HIPAA would be easy to understand and that providers would have compliance with HIPPA figured out. However, that just isn’t the case. This presentation will discuss recent cases and enforcement trends in the HIPAA arena. It will also discuss steps that providers must take to protect the privacy and security of its medical records to avoid being the subject of an Office of Civil Rights investigation.

The people who work at your business are your biggest expense but more importantly, they are your most valuable asset. If you do not know how to properly manage the most common legal problems with your employees, then you may end up defending yourself before an administrative agency or even a court. In this webinar, we will examine the most common HR issues for DME suppliers and offer some helpful solutions. Topics that will be covered include employee leave, the problem employee, the occasional harassment or discrimination allegation, employee performance issues, employees with claims of disability, and finally, how you are allowed to pay your employees.

An important way for a supplier to set itself apart from its competitors is to offer services to existing and prospective patients…services that other suppliers do not offer. And with the recent relaxation of the federal anti-kickback statute (“AKS”), the federal physician self-referral statute (“Stark”), and the federal beneficiary inducement statute, CMS and the OIG are encouraging the provision of “value-added” services to patients. At the same time, it is important that the supplier not go so far that it inadvertently violates these statutes. This webinar will discuss (i) the federal laws governing value-added services to patients; (ii) those value-added services that are legally acceptable; (iii) those value-added services that may trigger a government enforcement action.

In the past, it was not uncommon for a DME supplier’s payor mix to consist entirely of Medicare and Medicaid fee-for-service (“FFS”).  However, this is no longer the case.  The market is more competitive than ever, and industry initiatives such as competitive bidding has forced suppliers to expand their payor mix.  Today, about 35 percent of Medicare patients are on Medicare Advantage Plans, and about 70 percent of Medicaid patients are on Medicaid Managed Care Plans.  These percentages are increasing.  This program will discuss the challenges facing suppliers as they enter the managed care arena, including (1) the refusal of a Managed Care Plan (“Plan”) to allow new suppliers on their panels; (2) coverage and reimbursement policies that are different than FFS programs; (3) the prohibition against selling cash items to “covered lives” under the Plan; (4) a “take it or leave it” attitude by the Plan; and (5) Plans entering into “sole source” and “preferred supplier” arrangements.  Equally as important, the program will discuss the steps that suppliers can take to overcome these challenges.

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There are a number of synergies with sleep labs and DME suppliers that can make a relationship between the two types of organizations very beneficial. However, if an arrangement between a sleep lab and DME supplier is not compliant with fraud guidelines, it can be disastrous—resulting in fines, overpayments, and in worst case scenarios, criminal prosecution.  This presentation will discuss potential areas of concern including how to properly structure arrangements between the two entities including a discussion of permissible  compensation arrangements.

Regulatory guidelines, including Stark and the Anti-kickback statute, have been broadly written and construed.  They also have not changed much since they were initially enacted. However, the health care industry is drastically different with a shift away from fee-for-service payment models to more value-based models.  Both Stark and Anti-kickback guidance has recently been updated and allow for greater flexibility in certain situations.  Learn what changes have taken place and what effect these changes have on your arrangements with referral sources. 

The Distinction in Custom Mobility recognizes providers of custom mobility products who deliver exceptional, round-the-clock assistance to patients. Focus is on responsive care and services that improve activities of daily living and quality of life for patients requiring mobility support. Achieving this distinction certifies dedication to meeting specific needs of each patient.

The Distinction in Clinical Respiratory Patient Management recognizes the importance of respiratory care and specialty services, which have expanded significantly during the COVID-19 pandemic. Earning this recognition certifies excellence in managing respiratory conditions for home-based patients. Emphasis is on a collaborative, teams-based approach that encompasses assessment, treatment, documentation, and education to enhance quality of life and reduce hospital readmissions.

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.

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“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. 

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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.  

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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.