HME Reimbursement - A New Frontier

Let us guide you on your journey to timely and accurate payments

In dealing with third-party payers such as Medicare, Medicaid, and Medicare Advantage Plans, HME providers are feeling like they’re in the Wild West. It’s a showdown with those who serve the chronically ill and disabled and those who pay for it. How you get paid for the products and services you provide has changed, creating a New Frontier for HME providers.

In this journey, Dan Fedor and Ronda Buhrmester will guide you through this New Frontier and ensure you’re able to navigate the landscape to get to your destination—being paid timely and accurately for the products and services you provide.

VGM Education is accredited by the International Association for Continuing Education and Training and is authorized to issue the IACET CEU. VGM Education is authorized by IACET to offer 0.5 CEUs for this program. This program has been approved for 5 contact hours Continuing Respiratory Care Education (CRCE) credit by the American Association for Respiratory Care, 9425 N. MacArthur Boulevard, Suite 100, Irving, TX 75063. Sponsor ID #: 9366708. AARC Course #: 150428000.

RESNA recognizes CEUs awarded by the International Association for Continuing Education and Training (IACET). Only CEUs from an IACET authorized provider or accredited college or university are accepted for the ATP credential. In addition, the course must be focused on assistive technology.

To qualify for CEUs, participants must sign in at the registration desk, attend at least 90 percent of the presentation, and complete an evaluation form at the conclusion of the program.

Learning Objectives:

  • Draw an educated conclusion of when you can accept a payer’s rates with the current documentation requirements.
  • Discover viable options when you determine you can’t accept the patient’s insurance rates.
  • Judge if you are meeting your company’s financial objective to run a business.
  • Chart a course to get to the desired destination (customer care/financial sustainability).

Contact Ronda Buhrmester ([email protected]) or Dan Fedor ([email protected]) with questions.

Dates and Locations:

August 30 - Philadelphia, Pa.
Best Western Plus The Inn at King of Prussia
127 South Gulph Road
King of Prussia, PA 19406
Phone: 610-265-4500
Suggest a Location

Sessions run 9 a.m. to 3 p.m. Lunch Provided

Registration Information:

  • VGM and/or US Rehab Member = $100
  • Non VGM = $400
  • Non VGM but a state association member = $200

Breakout Session Information:

The Mobility Frontier

  • Documentation
    • Venture into physician and therapist education – How to convince them to allow you to help them
    • Documentation requirements path of least resistance for mobility assistive equipment.
    • Are you really asking for more than your competitor?
    • Prepping the claim for success.
    • Executing a valid ABN when necessary (denial, upgrade, and retail).
  • Claim Submission
    • Don't get snared by the Prior Authorization and ADMC TRAP.
    • Explore modifier logic.
    • Why claims get "stuck" and what you can do about it.
  • Denials
    • Uncover the most common denials and learn how to avoid them.
    • Learn to "speak their language" when appealing a denial.

 The Respiratory/General DME Frontier

  • Looking at the intake process (key component) that is in place, making sure the correct information is being gathered upfront. What is your process — bring to class with you.
  • Taking the medical policies not just one, but two steps further by identifying key areas to be on the lookout for when reviewing notes, test results, etc. (oxygen and CPAP).
  • Learn how to handle excess oxygen tank users as well as oxygen traveling patients.
  • Review repairs, specifically on capped rental products, making sure the money is being captured appropriately and having a good policy in place.
  • Discussing NIVs by making sure all the necessary medical records are being obtained and reviewed.
  • Is a valid ABN being obtained for upgrades (free or charging) for hospital beds?
  • Looking at areas where non-assigned claims are necessary due to low reimbursements and discussing how to handle these situations.
  • Conversing any hot topics that suppliers are being challenged with so solutions can be communicated.