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Legal: Request reviews thoughtfully

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01/22/2012

A. If you want to continue to pursue your appeal after an unfavorable ALJ decision, you can request review of that decision by the Medicare Appeals Council (MAC). The MAC, which is a part of the Departmental Appeals Board of the Department of Health and Human Services, is the next level of the Medicare appeals process after ALJ review. It is independent from the ALJs and conducts a "de novo" review, meaning it does not have to defer to the decisions issued in your appeal at previous levels.

Business assets: Maximize sales per customer

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01/22/2012

A. In most retail venues revenue models are built off of traffic. Traditionally, DME retail DME retail has been focused on physician or prescription driven business. A casual counter effect of this model is that customer service and loyalty never really seemed to be a focus. Customer relationships were often sacrificed by lack of sales training, product driven sales associates and information platforms required to maintain a profit producing retail model. Even today most DME retail venues focus first on insurance coverage and physician requests versus customer service and patient care. In turn, the intangible value to service many mediums of care, i.e. product sales, for each customer is often lost.

Collections: Reward employees for job well-done

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01/22/2012

A. Last month we talked about encouraging your patients to pay their bills. What about encouraging your employees to collect on those bills? Do you have an incentive program in place for motivating your billing staff? Many DME providers have implemented incentive programs with great results. This is something to seriously consider as a little stimulation can motivate your staff to go the extra distance in helping collect those balances.

Mergers and Acquisitions: Communicate clearly to alleviate fears

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01/22/2012

A. Many buyers fall into the trap of focusing solely on paperwork when purchasing a DME company. They negotiate the letter of intent. They finalize the purchase agreement. They review the strength of the Seller's claims, billing policies and procedures, focusing on due diligence. This concentration on paperwork is appropriate and necessary. But, for a truly successful purchase, the buyer must consider the paper as only half of the story; people are the other half of the equation.

Collections: Clearly communicate patient's responsibility

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12/27/2011

A. As a whole, the healthcare industry has taught patients to not pay their bills by stamping the phrase "insurance pending-don't pay" on the statement. While the bills you send may not include that verbiage, sending out statements each month without follow-up encourages payment delays. The patient's mindset can be difficult to change but it can and must be done.

Legal: Don't be caught off-guard by contractors

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12/27/2011

A. You may be surprised to learn that a Medicare Administrative Contractor or Qualified Independent Contractor will be part of your ALJ hearing, especially since the same contractor has likely already reviewed and denied your claim. However, these contractors now have the ability to participate in the Medicare appeals process at the ALJ level. What that means for your hearing depends on whether the contractor has chosen to be a participant or a party.

Business assets: Identify assets, expected return

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12/27/2011

A. Each marketing platform used for organic growth within your organization should be customized to the potential revenue gain. As you know, there are multiple mediums of marketing including direct mail, call center utilization and specialized retail sales platforms. To determine the best marketing source to capture the largest return on your investment you must first complete a mini business model identifying the targeted intangible assets to be used and your expected return.

Mergers & acquisitions: Protect yourself from take backs

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12/27/2011

A. Generally, indemnification clauses are designed to protect the buyer from a take back or recoupment based upon claims filed before the buyer purchased the company. I strongly recommend that every buyer consider including an indemnification clause in the agreement. But, in today's environment of ZPIC audits and 100% prepayment reviews, the indemnification clause alone may not be enough. Every buyer should review and verify all pre-sale claim compliance filed by the seller. Previous claims can have a direct impact on a buyer's on-going cash flow.

Legal: Make sure MA plans mirror Medicare

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11/21/2011

A. With few exceptions, coverage guidelines under a Medicare managed care plan must mirror those applied under original Medicare (Parts A and B) for the same items or services in the same geographic area.

Business Assets: Leverage all of your assets

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11/21/2011

A. An intangible asset is something that typically is reflected in the line item of goodwill when evaluating a business. The basic assumption is that an intangible asset could be anything that reflects value in a non-material form.

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