Consultant's corner: Providers tackle enrollment, technology in new year

Fighting that fear factor

VGM's Ronda Buhrmester spent the last two weeks of 2018 taking frantic calls from HME providers wondering whether or not they should change their Medicare enrollment status for 2019.

Her general advice: If you're a participating provider, change to non-participating.

“There's a fear factor, because it's a change in enrollment status for a lot of providers, and they're afraid of how it's going to affect their patients and their referrals,” said Buhrmester, director of reimbursement. “But it gives them the most options.”

Providers had until Dec. 31, 2018, to change their enrollment status for 2019 with Medicare's National Supplier Clearinghouse.

Non-participating status means providers can take assignment on a claim-by-claim basis. With an any willing provider provision allowing all Medicare-enrolled providers to provide DME to beneficiaries expected to shake up the landscape, they need that flexibility.

“They may want to wait a month or the first quarter before deciding what they want to do,” Buhrmester said.

If non-participating gives providers more options, why have providers traditionally enrolled as participating?

“That's a good question,” Buhrmester said. “Back in the day, the rates were reasonable, so it didn't matter.”

Participating status also puts a provider in the supplier directory. But most providers already have established relationships with the referral sources in their communities and Buhrmester guesses most of those sources use Google, anyway, if they want to search for providers.

“I think we're going to see an increased number of providers that went non-participating in 2019, I really do,” she said.

Luddites no more

If Miriam Lieber has one thing she wishes providers would embrace in 2019, it's technology—current and future technology.

“The notion of a patient being able to tap into their iPhone to know if they had a leak in their CPAP mask, that goes so far in the patient managing themselves and the provider managing the patient,” said Lieber, president of Lieber Consulting LLC. “That's really where it's at and it's here now.”

Lieber says providers also need to jump on technology that's not exactly here now, like an automated intake process using artificial intelligence.

“Checking and verifying eligibility is not straightforward today,” she said. “We need a more robust and automated intake process to find out who the payer is and how you can marry the payer with the authorizer, and what the documentation requirements are, etc.”

Providers have one thing pushing them toward technology, Lieber says: tight margins.

“They're realizing they can't do it alone and it's too expensive to hire more people,” she said.