Domos HME Consulting Group

In This Issue
Reimbursement Tips
Medicare Advantage Plans and Health Care Reform
Medtrade - Atlanta
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Fall 2010 Newsletter


This issue of our newsletter includes tips associated with Medicare required documentation for diabetic supplies and oxygen. Follow these tips and you'll be ready when the random Medicare audits arrive in your mail box!

Also in this issue, we invite you to check out our new web site. It's a virtual, always up to date, reimbursement handbook for DME providers that we think our customers will love. The new website was created in conjunction with our DME outsource billing service, and for a limited time, we have some free resources, outside the secure area that can be accessed by everyone - client or not.

I'm also including information about how the new health care reform bill may impact Medicare Advantage Plans -- in ways that might spell new opportunities for DME providers who are currently closed out of Medicare Advantage Plan networks.  

Finally, I want to invite all of our friends and potential customers to stop by and see us at booth 329 at the Medtrade show in Atlanta, Nov. 16th - 18th. We always enjoy the chance to chat with DME providers, and look forward to catching up with friends we haven't seen in awhile!

As always, thanks for subscribing!
Reimbursement Tips
Medicare is randomly auditing DME provider patient documentation like never before - it's an epidemic throughout the industry. Don't get caught on a technicality. Here are some tips to help you prepare in advance so you can breathe easy if you get hit with an audit request associated with diabetic supplies or oxygen equipment:

Diabetic Supplies:

1. If audited, you will need to produce physician progress notes that document the diagnosis of diabetes and that it is being treated by the physician ordering diabetic supplies. Auditors are not accepting the diagnosis simply because it is written on the prescription the physician signed.

2. Ensure that you document all the required elements of a resupply request: a) the date of the request/contact, b) the specific products being requested, c) an affirmation from the patient/caregiver that they have nearly exhausted their supply, and d) the employee documenting the request.

3. Ensure that the date of contact for resupply does not occur more than 7 days prior to the shipment; that the shipment does not occur more than 5 days prior to the end of the previous span date; that the shipment date is used as the bill date/date of service on the claim.

4. Document that the patient/caregiver was trained in the use of the diabetic testing supplies at the time of the initial supply (whether by the DME provider or other health care provider). Requiring the patient/caregiver to sign an acknowledgement of training is advised.

5. If audited, provide physician progress notes that prove over-utilizers have been seen by the physician every 6 months, and that include affirmation that the patient is testing at the prescribed frequency (or that you have a testing log from the patient to prove frequency of testing).


1. Obtain a copy of the qualifying test results before you deliver oxygen equipment. You will need to produce it if you are audited, and it protects you from delivering oxygen to a non-qualifying Medicare beneficiary.

2. If audited, you will need to produce physician progress notes that document that the patient received a face to face evaluation for oxygen therapy no more than 30 days prior to the initial date on the CMN.

3. If audited, you will need to produce physician progress notes that document that the patient received a face to face evaluation for continued need for oxygen therapy within 90 days prior to the recertification date on the CMN. If the patient misses the window you should hold your billing until the face to face required for the recert is complete.

There are a number of products that require a physician re-evaluation, or other documentation at some point, after the initial start of care date, as a condition of ongoing Medicare coverage (support surfaces, PAP devices, oxygen, TENS units, etc.). Like it or not, it is often the DME provider's job ensure that these requirements are met, whether it be prodding a patient to go back to see their physician, or following up with other health care providers to obtain additional documentation.

Most HME software billing systems provide tools to trigger this kind of follow-up by the DME provider. Spreadsheets and tickler files are a non-productive and error prone method of triggering these important follow-ups. We strongly advise our clients to learn what tools their software system provides to help put productive and effective follow-up processes in place.

In conjunction with its DME outsource billing services, Domos HME Consulting and Billing is pleased to announce its new website, Current clients, regardless of the type of consulting they receive, can access a virtual, always up to date, reimbursement training manual through the password protected Customer Portal section of the site.

The site contains reimbursement management training materials, general reimbursement tips, form templates, and best of all, cheat sheets and training handouts indexed by product. Just want information on PAP devices or diabetic supply billing? You can go right to it with a log in and password to the customer portal.

In addition, there is a free resource area on the site: HME Resources. And for a limited time, you can access our General Reimbursement tips handout as a way of sampling the resources on the site. This handout includes documentation tips, audit avoidance tips, common industry benchmarks for DME providers, and more.

Our current customers are invited to request a free log in and password to the site (send an email to, and include your company name in the request). If you're not a current customer, check out some of the samples available outside the secure area -- they are helpful as well.

Medicare Advantage Plans and Health Care Reform
Those of you who have met me know that I am a huge advocate for the independent DME provider. My experience in the industry, spanning well over 20 years, has shown me over and over again that independent DME suppliers typically offer a high level of caring and concern for their patients.  

Unfortunately, Medicare Advantage Plans offered by private insurance payers too often shut out independent DME providers, stifling the competition that allow our senior citizens to make choices based on the quality of care a DME supplier provides.

The Medicare Part D Drug benefit bill enacted by former President Bush and a Republican congress greatly expanded Medicare Advantage Plans by offering private insurance payers large subsidies to move seniors off of the traditional fee for service Medicare plan.

A silver lining to the recent health care reform bill will freeze those subsidies beginning in 2011, and then reduce them by an average of 12% per year until they are brought in line with the traditional cost of providing fee for service Medicare coverage. By 2019, Medicare Advantage plans will receive a total of $136 billion less than they would have received without these healthcare reform changes.

We saw this before between the Bush Sr., and Clinton administrations, and as subsidies decreased so did the number of private insurers offering these type of plans. Now, as then, these changes should slow the growth of Medicare Advantage Plans, and may even create a roll back of available plans when private insurers see their profits from the government subsidies evaporate. If you are an independent DME provider frozen out of Medicare Advantage Plan contracts this may work to your benefit.

But of course, we still have Medicare competitive bidding to deal with, so the fight goes on.
Medtrade Atlanta - Nov 16th - 18th

We're headed to Medtrade in Atlanta in a few weeks! We can be found in booth #329 at the show during exhibition hours.


I'll also be offering two seminar presentations during the show: Wed., Nov 17th at 9:15 AM - The Perfect Personnel File, and Thur., Nov 18th at 9:45 AM - The Perfect Patient File (which will include tips on Medicare required documentation).

Please feel free to stop by the booth and say hello if you have time. One of our favorite things about exhibiting at the Medtrade show is seeing our valued clients and friends.

Thanks for reading, and as always, please don't hesitate to call us with any questions!

Domos HME Consulting Group
phone: 425-882-2035
on the web: