Category: CMS

ALERT: Watch Your Net Revenue Carefully – CMS Changes are Draining Profitability for DME Businesses

September 21, 2016 Posted on Categories AR Review, Billing Service, CMS, DME

On July 1, 2016, the changes that CMS implemented to the durable medical equipment and prosthetics, orthotics and supplies (DMEPOS) went into full (100%) effect.

The impact of these fee changes on DME businesses cannot be overstated. While DME businesses are putting in just as much work to serve just as many patients, they are seeing their reimbursement rates drop by up to 50% overnight.

As a business owner, this is the time to look very closely at your business expenses to make sure you have minimized them. Without business process cost reductions, you will very likely end 2016 with a loss, even if it appears that your revenue is increasing.

Now is the time to pay careful attention not just to your gross revenues, but your net revenues based on reimbursement. That is where you will see the significance of CMS’s recent changes.

In an effort to support the DME industry, Bonafide is offering complimentary A/R reviews and advice to support each and every DME operator in maximizing their reimbursement rates this year and beyond to avoid the crippling effects of these fee changes.

Contact the team at Bonafide today to discuss our proven solution in securing years of future business success for your business.

How to Avoid CMS Audits

September 11, 2015 Posted on Categories CMS, Documentation

by Michelle Tohill

No matter how confident you are in how you run your business, the phrase “you’re being audited” can strike fear into everyone. The idea of having a comprehensive analysis of your system is bad enough, but it’s even worse to think of the time that may be required to comply with the requirements of the audit process. Thus, although audits are very necessary parts of our healthcare reimbursement system, they are definitely considered a significant disruption.


Here are four ways you can avoid audits in the first place. Taking these steps will also ensure that you are fully prepared in case you ever do fall under the watchful eyes of CMS.


1. Verify eligibility up-front for every patient.

The ability to verify payment eligibility up-front, before you file a claim, is critical in maximizing your reimbursement rates and avoiding future audits. Additionally, if you went through the process of verifying eligibility, you have now created a paper trail documenting your system that will be helpful if you are audited. The right software system can make this easier by providing instant eligibility checks.


2. Review documentation to ensure proper ICD9/ICD10 & HCPC coding.

Before you ever file a billing claim, you should make sure that you have the proper coding. This is a time-consuming but necessary step to ensure that you are reimbursed appropriately for the services and products rendered. It will be a red flag if your coding is consistently off, as CMS may interpret that level of inconsistency as a part of how you do business.


3. Keep/scan your supporting documentation so that it is available if needed for an audit.

Always ensure that proper documents are being scanned and provided to the billing department. Dated screen shots provide a good source of documentation, but whatever your system, make sure your record-keeping is meticulous so that if there are any individual questions it doesn’t spark questions for CMS and lead to an audit.


4. Educate your staff on required documentation to meet medical necessity requirements.

No matter how great you are as an individual, or how knowledgeable you are of how to avoid audit, at the end of the day your staff could be the main weakness in your business if they aren’t fully aware of the documentation and coding requirements. Talk with them regularly and monitor their execution of your standards to ensure they are taking the steps necessary to avoid audit.


Michelle Tohill is Director of Revenue Cycle Management of Bonafide Management Systems and oversees all billing programs and processes. Her specialty is conducting AR audits to expose inefficient billing practices that fail to fully reimburse physicians for their work. She conducts AR audits and provides Bonafide customers with training and consulting on how to improve every aspect of billing and practice management to maximize revenue.

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