Q&A: VGM's Buhrmester & Fedor

WATERLOO, Iowa - Just when HME providers think they have control over documentation and billing, Medicare throws them a curve ball. That makes it difficult for them to develop good habits—a big reason why they're turning up for The VGM Group's “Breaking Bad Reimbursement Habits” tour. Here's what Ronda Buhrmester and Dan Fedor, two reimbursement specialists for VGM who are running the tour, had to say in April about how providers are getting themselves on the right path to reimbursement.

HME News: You've had two tour stops so far. How has it been received?

Ronda Buhrmester: With the industry the way it is, with the cuts in reimbursement and the high number of audits, people are hungry for information and how to work through audits. They want to get paid appropriately and they don't want to lose their money. We've had anywhere from 30-50 attendees at the sessions.

Dan Fedor: They also like that we're coming to their backyards. It's less costly and less out-of-office time. The CEUs also attract people.

HME: What's one of the top areas where providers need to break bad habits?

Buhrmester: People think that, because they're billing non-assigned, they have no liability. That's not true. You're just telling Medicare that you're not accepting the fee schedule; you still have to follow guidelines, gather documentation and file a claim for the patient. That's misunderstood across the industry.

Fedor: The other part of that is, they're afraid to ask patients for the money upfront. They're afraid they're going to lose their referrals and lose the business. But that's not really happening. They're slowly becoming more comfortable with it.

HME: What's a good habit that providers need to develop?

Buhrmester: We all rely on physicians to do the documentation, but they don't do it like we want them to. There are other resources that we can add to that, as well. Someone from pulmonology rehab or a wound care clinic—you can use their notes in the supporting documentation. People miss that. Yes, you have to have the note from the physician that the patient has this condition, but you can also have other information that can help support that.

Fedor: I think another good habit to develop is not accepting an answer from a payer if it doesn't seem right. I had a provider who thought he had to rent complex rehab. I told him, you don't have to do that; there's a purchase option. He was doing it that way because that's what he was told by a Medicare customer service representative.

HME: But even when they break bad habits, providers always need to stay on their toes, right?

Buhrmester: Yes, you can have two different review nurses looking at a claim and they come to different conclusions. Who has the policy right? That is frustrating.

Fedor: There can be a lot of gray areas, so you need all the information you can get.