Notes from the field: diversification and billing

 - 
Wednesday, March 21, 2018

Medicare: Take it or leave it

Provider Roger Lichty has slowly transformed his business over the past few years so that vehicle mobility is now his No. 1 business.

Under the product category, Mobility Connection in Rockford, Ill., offers everything from wheelchair accessible vans to vehicle lifts to driving controls. The emphasis: cash.

“It’s actually what’s keeping us profitable at the moment,” said Lichty, owner.

Mobility Connection also provides personal mobility and home access products and services, as well as living aids.

The wheelchair accessible van business is increasingly dominated by chains, and there’s one such chain in nearby Chicago, less than two hours away. But Lichty says Mobility Connection has found success by emphasizing its broad product offerings and local service.

“People don’t like to travel to get their vehicle repaired,” he said, “and we can compete with them on pricing.”

Mobility Connection still has a Medicare number and with Lichty an ATP it still does some complex rehab business. But that business is getting fewer and farther between.

“We’re waiting for better things to come, if they come,” he said. “If they don’t, we’ll probably get out. We can survive OK without Medicare—we’re diverse enough.”

Watch those remittances

Medicare’s not the only pain in the side of mobility providers. So are commercial payers, says Sylvia Toscano, owner of Professional Medical Administrators in Boca Raton, Fla.

Toscano has noticed a trend of payers denying purchases for accessories for power wheelchairs across the board, even though they can be purchased or rented.

“We’re still having big struggles with these payers not processing claims for complex rehab according to contracts or per Medicare guidelines,” she said. “It’s a lot of administrative work; it’s a lot of appeals; it’s a lot of corrected claims.”

The likely problem: When these payers load the Medicare fee schedule into their systems, accessories are listed only as rentals, leading them to assume that’s the only option.

“I feel like CMS should have to include the modifiers for the items that can be purchased,” she said, which include NU (new purchase), BP (bennie purchased) and the list goes on—there can be eight modifiers on a claim.

Toscano says billing staff need to scrutinize remittances carefully to make sure payers are processing claims correctly.

“It’s easy to just let the system auto adjust, but you don’t want to auto adjust off those claims,” she said. “I feel like the carriers are hoping that providers post according to the remittances. You have to be actively looking for underpayments.”