How sweet it is…

Monday, October 25, 2010

WAUKESHA, Wis. – A new program at Oxygen One may not generate additional revenue, but it allows the provider to hold on to the Medicare reimbursement it collects.

Oxygen One began using an automated system earlier this year to call 350 oxygen patients each month to make sure they’re still living at home and still using oxygen at the time the provider bills Medicare. If that’s not the case, Oxygen One can’t bill.

“Everyone says it’s the patient’s responsibility to tell us, but that’s the last thing they think about when they end up in a hospital with a broken hip,” said Rebecca Olson, vice president of operations. “With Medicare going crazy with these audits right now, how sweet is it to have a program in place that guarantees you, before you bill, that yes, the patient was contacted and yes, they were home yesterday and yes, they were using their oxygen, and you have that month after month after month?”

Oxygen One uses a pre-recorded survey with voice recognition provided by medSage Technologies. It asks clinical questions like, “Have you been in a nursing home in the past month?” and “Have you had any respiratory infections in the past month?”

Billing agents at Oxygen One used to make the calls themselves, but Olson concedes that, with Medicare’s requirements becoming more and more onerous, the calls were getting left by the wayside.

“Most providers aren’t doing them all,” she said.

If patients are still living at home and still using oxygen and all else is well, Oxygen One does nothing more. But if there’s been some change, one of the provider’s clinicians follows up. On average, that’s the case about 20% of the time.

“One of our clinicians will call the patient and say, ‘You’ve had an increase in your shortness of breath and you’ve been on antibiotics, what’s going on?’” Olson said. “They say, ‘Well, the doctor did this, this and this, and I feel much better now.’ Alright. But sometimes that’s not the case. Then we can say, ‘Do you need us to come out and make sure your oxygen is working OK?’ It gives us an opportunity to be proactive.”

Before implementing the system, Oxygen One worried that it would get push-back from patients. But in October, seven months into the program, it had a connection rate of 90%, Olson said.

“I think we’ve sold our patient population short, when it comes to answering yes or no questions and pressing one and two,” she said. “We have a retiree who works in our warehouse part-time who said, ‘That’s the way all of my calls come in for my diabetic supplies. I think we’re used to it.’”

Olson likens using the program to having car insurance: You pay for it each month even though there’s rarely a problem, but it’s there if you need it.

“For less than $20,000 a year, we can do monthly calls and have peace of mind,” she said. “One Medicare audit could cost us tens of thousands of dollars.”