For years, it was common practice in the home medical equipment industry to admit customers to service without discussing the cost of an item or how much Medicare and/or insurance would pay and what, if any, co-payment would be due. It was also common to waive co-payments and simply accept the amount paid by a third-party payer as payment in full.
HME organizations are expected to have a good understanding of billing regulations for Medicare and any other third party payer source with which they participate or submit claims to. It is incumbent on the leadership of an organization to make sure that their billing practices are compliant with all regulations. An organization’s compliance plan addresses how the staff is educated and how the organization ensures and monitors billing compliance. The organization must have a process to admit a new customer to service where co-payments are explained and billing practices are discussed openly with the customer. Cost of care, information about co-pays and deductibles and any out of pocket expenses need to be addressed with customers at the start of services. It is a customer’s right to be informed of any amounts due and how their insurance (including Medicare or Medicaid) will be billed.
In the case of a Medicare customer receiving a piece of equipment that the organization anticipates will not be covered, an ABN (Advanced Beneficiary Notice of Non-coverage) should be completed and on file in order to bill the customer directly for the item if Medicare does not pay.
HQAA has several standards that address these issues relating to financial responsibilities. Some important ones to pay attention to include:
An informed customer is a happy customer most of the time. Solid policies and procedures, along with well-educated staff who understand these policies and procedures are the key to success with keeping your customers informed of their financial responsibilities. While they might not always be happy with the cost of their equipment, supplies, and treatments, keeping them informed up front will go a long way towards having good customer satisfaction with your services and staff.