Many physician practices are facing harsh economic times with Medicare payments continuing to be cut. Recent estimates adjusted for inflation claim physician payments, adjusted for inflation, have been reduced by an estimated 20% over the last decade. The bright spot is that DME payments are at least keeping pace with inflation, as the statutes governing DME payments are tied to the Consumer Price Index. Thus, preserving your DME enrollment has become ever more important as a vital economic pipeline for your practice.
As anyone who has recently had to re-enroll with Medicare knows, the application has become more cumbersome and complicated. Some applications are being returned requiring simple corrections while other practitioners are failing inspections. The good news is that there are experts who are very well versed in this subject and can provide your practice with an almost seamless reenrollment.
Back to the original issue, is that most physicians fail re-enrollment over very simple and minor issues, which if handled correctly from the start are totally unavoidable.
One such issue is the loophole physicians (MD/DO/DPM) have when completing their PECOS enrollment or re-enrollment for DME. Physicians can either list their actual daily hours for each day or simply post hours as “By Appointment Only”. Several reasons for not listing actual hours include:
Listing of hours leaves your office vulnerable to an inspection coming unannounced at any time during those hours. This can happen even if you are closed for lunch (and did not list that), a religious holiday, or if I can borrow a line from one of my favorite movies, “It was closed because everyone has the flu.” There are also no vacation, sick or weather-related days built into the listing by hours system. If you are a small practice and everyone is out at the same time no matter the reason and the inspector happens to come by that day you may have just failed the inspection.
Choosing hours also leaves you vulnerable to calculating the total wrong number from the sum of the hours listed on the application. One client recently had their self-submitted application, held up for more than 8 months. After reviewing the application, it turns out the total number of hours was inconsistent with the total daily hours from their signage. Fixing that and one other major issue seemingly has resolved their problem. Eight months’ worth of DME revenue could have potentially been lost and there are stories where worse has occurred. This could have been easily avoided!
Another reason for NOT listing hours and listing “By Appointment Only” is that unlike the unannounced inspection when listing hours, the latter option requires the inspector to contact your office prior to inspecting your facility. The inspector will do in order to ascertain your availability over the next few days or weeks . For example, they may ask, “When will your office be open next Tuesday?” This provides your office with the ability to schedule a range of times for a given day or other days. Choose a time range when your office personnel best suited to interact with the DME inspector are available. You won’t fail if they show up outside those hours. Also, you will be able to put the number of hours your office is open (e.g. 20) but won’t have to provide a specific daily time schedule. Because you can select “By Appointment Only”. This eliminates the hourly total error possibility.
Lastly, your signage will also be a great deal cheaper. You won’t be stuck with a schedule of hours and your signage can simply reflect, By Appointment Only. Of course you can accept walk-ins, if that is your policy.
Don’t forget that if you have listed hours and you change them, you are mandated to amend your PECOS enrollment. Failing to do so may result in a potential revocation of your PTAN if there is another surprise inspection during your enrollment period. This is simply so easy to avoid by not listing actual hours!
To conclude, the enrollment carriers are understaffed, underbudgeted and pressured by CMS to enforce the regulations to the letter of the law. The inspectors are not there to educate you.
Having someone on your side who is an expert and can hold your hand through the entire process, is a sure-fire way to make this a painless and seamless process. Physicians should take advantage of several loopholes in the DME process, which is something your expert can assist you with. In the right hands, the enrollment or reenrollment process can be inexpensive and a no worry slam dunk issue. Thus ensuring your ability to retain your PTAN and preserve a viable economic cash flow for your practice.
