Ways to expand your DMEPOS business.
All DMEPOS Competitive Bid contracts expired on December 31, 2018. The next bid program won’t take effect until January 1, 2021. During this Temporary Gap Period, DME businesses can take advantage of the time to prepare themselves for business growth – in the short term and long term.
1. Adding new products.
Although this was addressed in our March 2019 newsletter, we are reprinting the information because we receive so many phone calls from DME providers wanting to add products to their accreditation.
Adding additional products to your DMEPOS business is a great opportunity for you to increase the number of patients you can serve in your community. The DMEPOS competitive bid gap has created an expanded market for DMEPOS suppliers to add products that previously could only be dispensed by bid winners. You can also add non-bid products to expand your offering. For a complete list of Competitive Bid items for 2021, go to the Competitive Bid website.
Here are the steps to take if you want to add product codes to your approved product list.
Requesting Additional Products
- Email Kelly Haggerty (our National Scheduler). Include your company name and the specific products, including HCPCS codes, requested.
- Kelly will respond to let you know whether the product can be added via a file review* or if an on-site visit is required, and the associated charge. She will also send the necessary paperwork, and an “add product” checklist for use to be sure all elements are met.
- Be aware that the addition of some equipment may elevate your business to a different program level, with a resulting change in program fees.
*Please note that any paperwork sent in for a file review must not include any Patient Health Information.
Must Do’s before making the decision
- Assess the number of patient/clients in your area that would be likely to use these additional products.
- Contact referrals to see if they would choose your company for this expanded line of DME.
- Review the state licensure database on the National Supplier Clearinghouse website to determine if state license or licensed personnel is required for the products you wish to add.
- Review the HCPCS codes that you are considering adding on the DME PDAC website to determine whether the item is categorized as capped rental, inexpensive or routinely purchased, supply, etc. If adding orthotic/prosthetic products, be sure to verify whether the item is identified as off-the-shelf, prefabricated, or custom. Some states require licensed personnel for off-the shelf items, and the majority require licensed personnel for prefabricated and custom items.
- Review any relevant “Local Coverage Determinations” and/or “Documentation Checklists” on your DME MAC website to ensure a good understanding of the required elements for coverage.
- Review the Compliance Team DMEPOS Quality Standards to ensure that all evidence of compliance is met for relevant quality standards.
- Whether adding via file review, or on-site, your Accreditation Advisor will need to verify that your company has provided training to staff on the new products, customized related policies and procedures, created any needed forms and addressed any specialty quality standards that must be met (e.g., prefabricated/custom orthotics and prosthetics have additional quality standards in addition to general DME standards).
- Following the review and approval of any additional products, providers are responsible to update the PECOS account to reflect the additional products.
2. Home Infusion Therapy
There are three aspects to the new Home Infusion Therapy regulation:
a. External infusion pumps, which are a DMEPOS product;
b. Pharmacy, which provides the medications to be infused;
c. Home Nursing Care, which administers the drugs.
Typically, the pharmacy would be the billing organization, but the regulation allows for any of the three components to act as the billing entity.
Your opportunity, as a DME provider is to partner with a pharmacy to provide the pumps necessary for this growing medical model.
If you would like to investigate the viability of this service for your DME business, follow the steps listed in #1 above and then contact infusion pump manufacturers. Here is a reference list.
3. Respiratory Services
Choose to implement a program so your clinical respiratory providers can better engage with your chronic care patients. The Compliance Team’s Patient-Centered Respiratory Home™ (PCRH) is specifically designed to help respiratory care professionals perform at the top of their licenses and guide clinical respiratory providers to more effectively engage with their chronic care patients. For more information on how you can receive this DMEPOS sub-specialty designation, call The Compliance Team at 215-654-9110.
4. Remote Monitoring
Remote Patient Monitoring is a growing aspect of Telemedicine. By 2014, remote patient monitoring is expected to bring in over $30 million. If you are not already selling remote monitoring equipment and services, you may want to consider it. Remote patient monitoring allows patients to maintain independence, avoid complications, and reduce costs. Services are covered by insurance and Medicare. Your opportunity is to sell the monitoring equipment or offer/recommend a service that provides monitoring. A perfect example would be Home INR Monitoring.
Sandy Canally, Founder and CEO, on expanding your DME business
Competitive Bid Product Categories:
Competitive Bidding Timeline
The Centers for Medicare & Medicaid Services (CMS) announces the pre-bidding supplier awareness program
CMS announces bidding timeline and begins bidder education program
Registration window opens for the DMEPOS Bidding System, DBidS, and Connexion, the program’s secure portal
Bid window opens
DBidS registration closes (Connexion registration always remains open)
Covered document review date for bidders to upload financial documents in Connexion
Bid window closes
Preliminary bid evaluation notification
CMS announces single payment amounts and begins contacting process
CMS announces contract suppliers
Implementation of Round 2021 contracts and prices
* Dates listed are target dates. Actual dates will be announced through listserv notice.
DMEPOS commonly cited deficiencies
Deficiency (Patient Services PTS 5.0)
The organization does not perform timely follow-up and/or does not document follow-up care.
Both The Compliance Team’s DMEPOS Quality Standards and the CMS Supplier Standards specify that suppliers are to perform patient follow-up, consistent with the type of equipment, services or items provided, and be in accordance with recommendations from the prescribing physician or health care team members.
At the time of delivery, patients or caregivers need to be made aware of the follow-up policy and plan.
When providing any devices that are classified as category 2 or 3 by the U.S. Food & Drug Administration (FDA), it is necessary to have a written policy and procedure describing the process for equipment-related follow-up of patients by phone or visit (template is available for TCT clients if needed). Whenever unsure of the product classification, verify via the FDA website.
For any equipment classified as group 2 or 3, follow-up should occur within at least 72 hours of the initial set-up, and then on an as needed basis as determined by patient needs, prescribing physician recommendation, or as regulations require.
All follow-up care performed must also be documented in the patient record.
“I chose your company because you are ‘woman owned.’ I have found, without exception, in working in corporate business for over 40 years, that if you want something done right and thoroughly, choose a professional-level woman.” – Nita Bechtel, Compliance Officer, York and Company Pharmacy, Richland, MO
Exemplary Provider Decals
We have new Exemplary Provider digital decals that you can add to your website or to your marketing materials. You can choose between generic or custom decals that include the accreditation tracks e.g. DMEPOS, Community Rx + DMEPOS, Long Term Care Pharmacy, Specialty Drug. Contact Marilyn, our communications advisor, for details, email@example.com.