Hot-Button Business & Regulatory Challenges Facing 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.
The New Competitive Bidding: The “Gap” Period and Preparing for Round 2021
Competitive Bidding contracts ended on December 31st 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.
The attendee will be able to discuss the implementation of the next round of competitive bidding, Round 2021.
The attendee will understand what steps it should begin taking to submit a bid packet for the next round.
The attendee will be able to discuss reimbursement policy for products supplied during the gap period.
Successful Performance Improvement: The Heart of Financial and Clinical Success
W2 Employee vs. 1099 Independent Contractor: Under the Law, There is a Huge Difference
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.
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.
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.
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.
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?
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.
Innovative Marketing and Arrangements with Referral Sources
The DME supplier is caught in the “Perfect Storm” of competitive bidding, low reimbursement, and aggressive audits. This challenges the supplier to handle the increasing demand while generating a profit.
A successful supplier sets itself apart from its competition by implementing an innovative marketing program, and entering into strategic arrangements with physicians, hospitals, and other referral sources. It is important that the supplier not run afoul of federal and state anti-fraud laws.
This program will discuss anti-fraud laws that govern marketing programs and arrangements with referral sources. Examples include:
Federal anti-kickback statute
The Stark physician self-referral statute
The beneficiary inducement statute
Equally important, this program will discuss the types of marketing programs and arrangements with referral sources that are legally acceptable, that fall within the proverbial “gray area,” as well as those that are downright prohibited.