The team over at MiraVista LLC recently sent out an email that got us thinking. In the email, a scenario was posed concerning a patient who had not been paying their monthly co-pay. With federal law and insurers requiring that providers make a reasonable effort to collect co-payments, what is the best strategy for the situation? Let's take a deeper look at this scenario and discover if people or technology can help alleviate the problem while still providing care for the patient.

The full scenario posed by the MiraVista research team:

"Let's consider a patient who is two years into the oxygen cap, and each month they accrue about $25 in monthly coinsurance. Because the patient has not been making any payments, their total account balance has reached over $400. They will not return any of the provider's calls to set up payment arrangements. Can the provider pick up the equipment? What does Medicare policy say about this scenario?”

HME providers should take care to research the Medicare guidelines carefully. Generally speaking, however, Medicare leaves the decision of whether or not to provide a beneficiary with DME/HME services up to each provider. For many products and services, providers are also allowed to cut off service if payments have gone unpaid—much like in any other situation.

But what about oxygen? Aren't there different guidelines?

The Medicare Oxygen Policy Article states:

“The supplier who provides oxygen equipment for the first month must continue to provide any necessary oxygen equipment and all related items and services through the 36-month rental period.”

The policy article provides for four exceptions to the general rule:

• The beneficiary relocates (temporarily or permanently) outside the supplier’s service area.
• The item becomes subject to competitive bidding.
• The beneficiary elects to obtain oxygen from a different supplier.
• CMS or the DME MACs make an individual case exception.

Unfortunately, none of the above permit providers to discontinue oxygen service for nonpayment.

So, now what? Is there anything that can help an unpaid provider?

In an email from AAHomecare, we were reminded why reasonable effort must be made to collect copayments:

• Federal law requires DME suppliers to make a reasonable effort to collect copayments from commercial insurers, including Medicare Advantage Plans.
• Failure to do so can result in liability under the federal anti-kickback statute, beneficiary inducement statute and False Claims Act.
• Many criminal and civil cases have been brought against DME suppliers for not making a reasonable effort to collect copayments while some insurers will terminate agreements with them on the same basis.

In their email, MiraVista mentioned "inconsistent and unsatisfying" results when providers attempted to pursue the matter via collection firms and litigation. Getting the customer to switch providers is also a hard path to take. On the one hand, the other provider may refuse and on the other hand, there's a patient who still needs care.

MiraVista proposes a possible solution:

"Perhaps the best practice is to involve intake and resupply teams in the effort."

Oxygen users are counting on providers to help keep them healthy and safe—and that includes getting the right supplies at the right time. By staying in sync with intake requests and utilizing payment talk during resupply calls, providers can address two birds with one stone—ensuring not only the patient's wellbeing but also taking steps towards receiving authorization for both past due bills as well as future ones!

How the Intake & Resupply teams can help:

• Follow their company's standard operating procedures and be mindful of regulations and requirements.
• Get complete contact information (cell phone, land line, email address, caregiver information, etc.) to ensure that they can contact the patient using more than one method.
• Store any acquired patient financial agreements for patients electronically in the billing system. Enter acquired patient credit card information so that it is readily available when it’s possible to bill the patient portion. NOTE: Credit card information is tokenized and PCI compliant.
  • Know when they are permitted to bill the patient’s credit card.
  • Follow a standard practice when billing patient credit cards.

How software and technology can help:

Broadening our view to all HME/DME products including frequently used supplies, not just oxygen, there are several built-in pieces of functionality that providers can utilize in TIMS to capture payment information and manage caregiver information.

• TIMS Credit Card solution collects patient portion either up front or during the order and resupply process.
• TIMS Patient Subscriptions is a suite of tools that specifically manages the entire resupply process.
  • Patients are easily enrolled during intake.
  • The software completes and reports on automated compliance checks (eligibility, utilization, documentation, and authorizations). These checks begin 28 days before an order is needed so exceptions can be worked.
  • Patient contact options (phone, email, text, or IVR) are turned into worklists that can be completed manually or via automation.
  • Qualified orders are auto-generated for delivery or eDrop ship. 

In the present competitive climate, you need automation, security, and performance to grow and succeed. TIMS brings you these and more as the most comprehensive business management solution for today’s home medical equipment providers. Whether you are seeking a cloud-hosted or traditional on-premises option, the choice is yours.

Our software suite includes revenue-qualifying patient intake, efficiency-boosting workflows, automated resupply, compliance-based document management, data analytics and reporting, collections and denials worklist, mobile delivery, ePurchasing, eDrop shipping, asset tracking, inventory management, and more.

TIMS is a fully integrated system robustly designed to optimize your outcomes. It seamlessly synchronizes data in real-time from your entire revenue cycle, including from the TIMS mobile apps. It’s also a customizable solution made to fit your unique business needs. And our company’s USA-based support services will be there for you every step of the way.

Simply put, through technology, tradition, and transformation, our company and software products are the strategic partners you need. We deliver the right mix of software, service, and support that will empower you to grow your business to its fullest potential.

Last updated February 15, 2023.