From The Mouths of the DME Companies

Today’s Wound Clinic interviewed representative from several leading DME Companies to explore how their business help in the wound care clinic space. The following companies participated in this interview:

National Rehab

Location: U.S. Corporate Office: Airside Business Park, 540 Lindbergh Dr. Moon Township, PA 15108 Website: www.nationalrehab.com Interviewee name and title: Cheryl L Hutton, BSN, RN, CWON Clinical Director 1) What a clinician needs to know about using a DME company? When choosing a DME Company, the clinician needs to know what product lines the DME offers, what insurance contracts the DME services, what areas they ship and how they receive orders. They also should have an understanding of the shipping time and costs the DME offers, how returns are handled and if they are certified. Some DMEs may charge the patient for expedited freight so they have to choose between a slower delivery or incurring costs. At National Rehab (NR), all initial wound care, urology and ostomy orders are shipped free, next day to the patient’s home. A clinician should also ask what value-added services a DME offers in the way of clinician and patient education and service. NR provides access to two full-time WOCNs as well as CEU courses. 2) And what is required of the clinician so you can access those things? Clinicians should be aware of the documentation a DME supplier will or may need to fulfill their patient’s order. For wound care, this would include demographic data, insurance information, wound measurements, description of the wound bed and periwound condition. The clinician should also be willing to provide supportive medical record documentation. Though it can be time consuming to provide the documentation, it can be problematic for the facility and patient later if the documentation is not provided upfront. 3) Do the providers use the Negative Pressure LCD as a guidance document for order, utilization, and documentation? When choosing a DME provider for NPWT, the CMS LCD is KEY for the clinician to understand. A DME will need the clinician to complete a Certificate of Medical Necessity (CMN) for the NPWT product. The DME will also require supportive medical record documentation as well. 4) What recommendations would you like to give the providers regarding surgical dressings, negative pressure wound therapy pumps, wound suction pumps, off-loading devices, etc. Do your homework when searching for a DME provider in these areas. Choose a DME who has a history of success providing these products for their referral sources and patients. When placing an order with a DME, specify the amount of product the patient will need as well. This will ensure that your patients receive only the product amounts that they will use. The customer service and sales teams for the DME should know the appropriate guidelines and be able to be of service to the clinician. 5) What problems do you face pertaining to physicians' orders for surgical dressings; negative pressure wound therapy pumps, wound suction pumps, off-loading devices, etc.? A DME needs to be able to provide multiple options for surgical dressings for their referral sources. A physician may order a specific brand name product that the DME may not either be willing or able to provide either because there is no HCPCS billing code for the product or the cost of the product to the DME exceeds the reimbursable amount. There are also times that the physician orders are not complete, the insurance information is outdated, and this can delay shipment of product. 6) What "ordering" recommendations do you have for providers? Find out what ordering method works best for your care setting or office. Orders usually may be placed by phone, fax or electronically. Try not to place orders at the end of the business day. This is a very busy time for most DMEs with many end-of-day orders being placed while they are also processing orders from earlier in the day. If you have specific products your office uses, ask the DME if they would be willing to do a custom order form for you. 7) What are the major documentation deficiencies that you encounter? Misspelled patient name Incorrect insurance numbers No wound measurements No physician/prescriber signature Medical record documentation does not match the Certificate of Medical Necessity Illegible writing on fax forms 8) What documentation suggestions would you like to give providers? If you have access to EMR system for orders, use it. This will save both you and the DME time, ensuring the patient gets the order promptly. Verify patient insurance, name and address/contact information on each visit. 9) Do you have any suggestions to assist providers justify the medical necessity for surgical dressings, negative pressure wound therapy pumps, wound suction pumps, off-loading devices, etc.? DME providers should be able to assist with information regarding the coverage policy of the patient’s insurance. They also should be able to provide you with CMS/Medicare guidelines for all product lines they service. The customer service and sales teams should be able to answer questions for you. Check the DME’s website and ask for the education. Remember, a DME should be much more than a supply delivery service for your patients. They should be a partner. 10) What reimbursement advice would you like to offer to providers who order your product for their patients? If you are ordering from National Rehab (NR), please call customer service, sales or the clinical team at 1-800-451-6510. NR also has two full-time WOCNs who are available to answer clinical questions you may have. The customer service and sales teams are educated on reimbursement guidelines for all the product categories we offer. 11) What reimbursement advice would you like to offer to the clinicians that bill Medicare for your product? For a Medicare patient, know the Medicare coverage guidelines for the product category you are requesting. The key question to ask any manufacturer regarding a product that you want to offer an outpatient is: “Is there a HCPCS code for the product?” If there isn’t a code, most DMEs will not carry the product because Medicare will not reimburse for the product. If there is a code, call your DME supplier and ask if they have the product in inventory. If they don’t and you would like to use it for your patient, ask if they would be willing to order it. If the cost of the product exceeds the reimbursement to the DME supplier, they may choose not to bring in the product.

Prism Medical Products, LLC

Location: U.S. Corporate Office: 1328 N. Bridge St., Elkin, NC 28621 Website: www.prism-medical.com Interviewee name and title: Kenneth Reel, VP of Sales 1) What a clinician needs to know about using a DME company? A clinician should know that a DME company works for them, their staff and their patients. For patients who don’t have a preferred DME provider a clinician and their staff should assist the patient by suggesting a DME company that is willing to provide individualized/customized service that meets the needs of that particular clinician/facility/patient. 2) And what is required of the clinician so you can access those things? I would suggest sitting down with a representative from the DME company to discuss the philosophies of the clinician/facility. Not every DME company will be a good fit. I my experience delivery time, product selection, the ability to process/handle insurance related issues, and effectively communicate with the clinician/facility and patient are the most frequent issues facing a clinician/facility. These points of service should never be sacrificed and a DME company should be willing to effectively meet these and any other needs the clinician/facility may have within the limits of proper regulatory guidelines (Federal, State, Accrediting Organization, etc …) 3) Do the providers use the Negative Pressure LCD as a guidance document for order, utilization, and documentation? N/A. Our company specializes in the home delivery of surgical dressings, ostomy and urological supplies. 4) What recommendations would you like to give the providers regarding surgical dressings, negative pressure wound therapy pumps, wound suction pumps, off-loading devices, etc. Providers should know that their facility and patients do not need to do without top notice service. DME companies should be service providers. We work for their patients. There are many companies to choose from. Don’t be afraid to demand the best and hold your DME company accountable. If a provider is told something can’t be provided the provider should not hesitate to know why. 5) What problems do you face pertaining to physicians’ orders for surgical dressings; negative pressure wound therapy pumps, wound suction pumps, off-loading devices, etc.? As a company that attempts to process, pack and deliver every order within 24 hours the lack of patient demographics and wound assessment are the two major hindrances we face in attempting to provide the patient with quick/timely service. 6) What “ordering” recommendations do you have for providers? Find a process that works best for you. Fax, phone, email, utilization of your EMR or hard copy medical record all will commence the order process in regard to surgical dressings. As long as your DME company knows where the order is coming from, who the order is for, and what products you want for you patients while including a wound assessment and patient demographic then your order should be filled and process timely. Remember, though it is helpful to have a provider’s signature, it is not necessary to fill the initial order. However, it is necessary to process billing with the patient’s insurance provider. 7) What are the major documentation deficiencies that you encounter? As discussed previously, lack of patient demographics and wound assessment are the two major documentation deficiencies because these items delay processing the initial order. Lack of provider’s signature would the third major deficiency because it delays billing for the requested DME related products. 8) What documentation suggestions would you like to give providers? In regard to surgical dressings, most providers do not realize that they may place an order by submitting their EMR or hard medical record. Many times these records document where the order is coming from, who the order is for, what products the provider wants for their patients and a wound assessment. Hence, a provider’s medical record plus a patient’s demographic will many times allow a DME company to process an order without the need to fill an actual order form, thus saving the provider and/or their staff valuable time. 9) Do you have any suggestions to assist providers justify the medical necessity for surgical dressings, negative pressure wound therapy pumps, wound suction pumps, off-loading devices, etc.? In regard to surgical dressings certificates of medical necessity are not generally required to fill an order. However, please remember to include a diagnosis (ICD9 Code or Description i.e. diabetic ulcer of the lower limb), wound size and location as well as wound exudate levels in the wound assessment. 10) What reimbursement advice would you like to offer to providers who order your product for their patients? In regard to surgical dressings Medicare is the great equalizer. Providers should know that DME companies/third party billers submit the “A” code associated with the product not the product brand name for reimbursement. If the product you want has a valid “A” code and associated fee schedule you should get the product you want regardless of profitability to your DME supplier. Many times I hear providers tell me that their current DME company will provide calcium alginate “A” but not calcium alginate “B” due to do the fact that calcium alginate “B” is not covered by insurance. Many times calcium alginate “B” is covered by insurance however reimbursement value for calcium alginate “B” causes a profit loss for your DME provider. Remember, profitability of the DME company should not take priority over patient care. 11) What reimbursement advice would you like to offer to the clinicians that bill Medicare for your product? N/A. We supply directly to the patient, not the clinician/facility. Hence, we handle all patient related billing/reimbursement issues.

Wound Systems, LLC

Location: U.S. Corporate Office: 1530 Dunwoody Village Parkway, Suite 115 Website: www.woundsystems.com Interviewee name and title: Tim Graves, CEO 1) What a clinician needs to know about using a DME company? If possible, the clinician should have basic knowledge of the DME’s product offerings. 2) And what is required of the clinician so you can access those things? A clinician needs to have access to facility policies, protocols/formulary’s and physician’s orders before contacting a DME for the appropriate equipment. 3) Do the providers use the Negative Pressure LCD as a guidance document for order, utilization, and documentation? N/A 4) What recommendations would you like to give the providers regarding surgical dressings, negative pressure wound therapy pumps, wound suction pumps, off-loading devices, etc? With respect to replacement therapy surfaces, if possible, be proactive and stay in front of the treatment process and not in “catch up” mode (wind-milling), then once the wound is healed and given patient risk assessment, remain proactive to help prevent future breakdown. 5) What problems do you face pertaining to physicians’ orders for surgical dressings; negative pressure wound therapy pumps, wound suction pumps, off-loading devices, etc.? With respect to replacement therapy surfaces, lack of understanding about new technologies and products that are available for use, many of which are less expensive than traditional products. 6) What “ordering” recommendations do you have for providers? With respect to replacement therapy surfaces, and to the degree possible, advance notice, along with proper documentation outlining placement location, as well as, better communication between clinicians from one shift to another regarding orders for particular patients. (i.e. ordered on one shift and not communicated at shift change) 7) What are the major documentation deficiencies that you encounter? Inconsistent and illegible completion of facility forms. 8) What documentation suggestions would you like to give providers? Understand facility document requirements and then be consistent in using them. 9) Do you have any suggestions to assist providers justify the medical necessity for surgical dressings, negative pressure wound therapy pumps, wound suction pumps, off-loading devices, etc.? With respect to replacement therapy surfaces, be open to DME vendor in-service sessions to understand what products are available and then “trial” them to see if they are useful. 10) What reimbursement advice would you like to offer to providers who order your product for their patients? Understand facility policies and patient coverage before ordering equipment. 11) What reimbursement advice would you like to offer to the clinicians that bill Medicare for your product? Understand billing codes before ordering equipment.

Advanced Tissue

Location: U.S. Corporate Office: Little Rock, Arkansas Website: www.advtis.com Interviewee name and title: Kevin Lamb, CEO 1) What a clinician needs to know about using a DME company? Not all. DMEs are the same. It is important to seek out a company that is an industry leader as well as someone that follows industry and Medicare guidelines. Seek a DME provider that is accredited by a recognized accreditation organization, many have selected accreditation by any organization that will fulfill the bare bone requirements to maintain their Medicare number. 2) And what is required of the clinician so you can access those things. In order for a clinician to work with Advanced Tissue they only need to provide patient demographics, wound documentation and what wound care supplies they would like the patient to receive; a very straight forward and simple process. 3) What recommendations would you like to give the providers regarding surgical dressings, negative pressure wound therapy pumps, wound suction pumps, off-loading devices, etc? We have a saying at Advanced Tissue: You be the clinician. We'll be the supplier. We believe the clinician knows what is best for their patients; therefore, we don't provide recommendations as to what they should use. 4) What problems do you face pertaining to physicians' orders for surgical dressings; negative pressure wound therapy pumps, wound suction pumps, off-loading devices, etc.? The Medicare guidelines are very clear on what we must have in order to fill orders, we have had situation where an order is delayed in process due to incomplete or inadequate information. So the order is not delayed while we are waiting on necessary information from the clinic it is important the patient information is correct and the products ordered meet Medicare guidelines as related to the wound description. 5) What "ordering" recommendations do you have for providers? To provide complete patient information, proper wound documentation as well as order products that are recommended for use within the Medicare guidelines per wound description. 6) What are the major documentation deficiencies that you encounter? We must have patient information (DOB, Social Security Number) as well as wound information (size, depth and drainage) in order to process orders. Without this information we cannot process orders. 7) What documentation suggestions would you like to give providers? By providing the necessary patient and wound information when the order is placed, the order processing can begin immediately and the order can be handled promptly. 8) Do you have any suggestions to assist providers justify the medical necessity for surgical dressings, negative pressure wound therapy pumps, wound suction pumps, off-loading devices, etc.? The patient wound information; size, depth, drainage and description of the wound will justify what products or approach should be used. 9) What reimbursement advice would you like to offer to providers who order your product for their patients? Our product is service; they can be assured Advanced Tissue follows Medicare guidelines and we will only ship the products they order for their patients. 10) What reimbursement advice would you like to offer to the clinician’s that bill Medicare for your product? Advanced Tissue bills Medicare for the supplies we ship to patients so the clinician doesn't have to worry with that aspect