Transcript Durable Medical Equipment Training

Durable Medical Equipment
Prosthetic and Orthotic Supply
Training
Presented by:
Leonard Peel
National Sales Director
SS Medical Supply
Experience the “non-pharmaceutical”
approach to treating arthritis and joint
pain.
Many healthcare professionals have realized the important role
braces and supports play in alleviating arthritis and joint pain in
general. Many patients experience adverse side effect when they
take pain medications.
The benefits of using these devices are:
Increased mobility
Increased circulation
Reduced swelling
Pain relief
Here are some interesting statistics
• 65% of people over the age of 65 suffer from
some form of Joint pain including arthritis, lupus,
gout and fibromyalgia
• More than 50 million people are affected and the
projection is 67 million people by 2030
• 30 million suffer from diabetic conditions
How can we help those in need of pain relief?
By offering these devices to those you already know or
to those you just met who have joint pain you will:
A. Alleviate their pain
B. Lower their dependency on drugs
C. Actually save Medicare and insurance companies
money
D. Give yourself another product and service to
offer your clientele
Diverse Product Line
(Something for any condition Just a small cross-section of products with many more available)
How do you market DMEPOS?
Current clients and their referrals
Friends and relatives
Senior community centers
Low income housing authorities
Physicians
Physical therapists
Independent living facilities
Health fairs
Churches
Getting Started
• Call on your current clients or other contacts
• Ask them if they are experiencing chronic joint pain and are they
being treated for it
• Set a time to meet with them to assess their needs and to get proper
measurements
• Have them contact their doctor and inform them that they will be
receiving a prescription for DME
• Fax in your completed order to the DME supplier
Reference
Many of the product lines we carry have websites. If you have not visited their website, please feel free to visit
www.thermoskin.com/ as well as www.ossur.com and look at the array of products available. These are supports
your patients/clients wear in areas of the body where they are feeling joint pain, whether from Arthritis, Diabetes,
injuries, or various different reasons. These devices are designed to relieve pain by providing consistent warmth
with increased circulation, reduced swelling and improved mobility.
SS Medical Supply Inc. has been operating since 2001 and is fully accredited and Joint Commission Certified
which holds them to the highest of industry standards. Knowing the business and how to get carriers to pay you is
crucial to the success of DMEPOS. http://ssmedicalsupplyinc.webbusinessdoctors.com/index.html
What really set`s SS Medical Supply Inc. apart from all of the other DMEPOS providers is our commitment to the
success of our sales force.
Our product line includes arthritic braces for all body parts, diabetic supplies, power wheel chairs, scooters,
hospital beds, CPAP machines and many other ancillary products all from a multitude of top rated vendors.
Basic Training Guide
What do you do as a Consultant?
The products you are offering are covered (reimbursed) by Medicare and Most Private insurance
companies with a physician’s prescription. Patients are not asking for a prescription for pain
medication. These are products that they can purchase over the counter, or have their doctor
prescribe and have insurance pay for it!
Ask the patient where are they hurting and what products they are requesting.
NEVER REQUEST MORE THAN WHAT THEY ARE REQUIRING OR EXPRESS A NEED FOR.
If only one knee is afflicted, then request only one knee device.
(There are numerous devices from different vendors so be sure to specify the device and the
company name on all of the forms.)
Refer to you “Sample order”
documents and follow them as a
guide for this portion of the
“Basic Training”
(These were previously emailed to you and they are the slides following the
each detailed instruction slide)
The Paperwork
Patient Assessment
(Reference sample forms)
This form must be completed and signed by the applicant.
Name and date of birth are required as well as crucial. Be sure their name is correctly spelled like on their
Medicare card. Also, be sure they know the D.O.B. that Medicare knows. The best solution for this is to have
them call their pharmacy (if they have an issue) and ask the pharmacy what D.O.B,. they have on file.
Check yes if they are experiencing joint pain and yes if they have seen a doctor for this pain.
If no to both, they do not need these products.
Do they have OA or Rheumatoid arthritis?
When were they last seen for these conditions? If it has been more than 4 months the Doctor will require a visit
before signing the prescription sent by us.
Give a description of the pain they are experiencing. Find the appropriate body parts and fill in a yes and left or
right or both like the example. Measure the applicant as stated in the guide.
Call their doctors office and use the script provided for “patient’s instructions for calling their doctor”. Be certain
to do this step. Be sure and note who was spoken to for future reference.
Patient Consent
(Reference sample forms)
This form need to be completed and signed by the applicant. The boxes must be checked.
When the products arrive they include this information. However, we need their consent to process the order.
This also gets faxed in with each order. No need to go into full detail about each box. Briefly explain that the
patient has rights under Medicare that allow them to choose to have these products. Conditions do apply that
protect the consumer.
Billing Intake Form
(Reference sample forms)
Who does Medicare say your patient is, and where do they live?
Who is the Doctor that will prescribe these items, if they feel necessary?
Who are we billing? Insurance Information
What are we ordering for the Patient? How many, and what size?
Ask the Patient to get their Medicare Card out, even if they don’t use their Medicare Card.
If the patient is not covered by Medicare, skip this part and go to the insurance information section.
Make sure they have Part B listed – DME is covered on Part B!
NAME: Very Important: Write down the name exactly as it appears on the Medicare Card, even if they
say it’s misspelled! Last Name, First Name, and don’t forget Middle Initial or Middle name if it is listed! This
must be exact. If the first name is abbreviated, then write it down as it is listed. If no Middle Initial is listed,
then don’t write it, etc.
Patient Consent Sample
SS MEDICAL SUPPLY
Durable Medical Equipment Prosthetics Orthotics Supplier
501 S, Falkenburg Road, Suite E18&19, Tampa, FL 33619 Office:800-657-4090 Fax:-866-626-7881
Patient name: ____________________________________________ Medicare #___________________________
As spelled on Medicare Card Use Social Security Number if not on Medicare
PATIENT CONSENT
I certify the information given by me in applying under title XVII of the Social Security act is correct. I authorize any holder of
medical or other information about me to release it to the Center for Medicare and Medicaid Services or its agents any
information needed for this or a related Medicare claim. I request that the payment of authorized benefits be made on my
behalf. I assign benefits payable for services of SS Medical Supply to be paid to SS Medical Supply or authorize SS Medical
Supply to submit a claim to Medicare for payment for me. Assignment of Medicare claims does not mean that Medicare pays
your entire bill. Patient’s responsibility on assigned Medicare claims includes payment of:
Annual Medicare deductible
20% co-insurance on approved services
Non-covered services
Services rendered under a waiver of liability, approved, but not paid by Medicare
I hereby acknowledge that I have been given a copy of the “Privacy Notice”. This notice describes how health information may be used and
disclosed and how a patient can get access to their health information. I have been advised by SS Medical Supply to read this document
and to forward any questions to their Compliance Officer at 800-657-4090.
I certify that I have been instructed and understand the complaint and warranty policy as well as the customer instruction for use.
I have read and consent to receiving information on the products supplied.
I have read and consent to receiving the Supplier Standards.
I have read and consent to receiving the Patient Bill of Rights.
I have read and consent to receiving notification of how to voice a complaint.
I have read and consent to receiving Equipment Warranty and Return Policy.
I have read and consent to receiving the Patient Grievance Letter.
I have read and consent to receiving the Mission Statement from SS Medical Supply
I have read and consent to receiving the Patient Satisfaction Survey.
I authorize any holder of medical information about me to be released to SS Medical Supply or my insurance carrier any
information necessary to determine benefits and payment. I permit a copy of this authorization to be used in place of the
original.
Signature of Patient: ___________________________________ Date: ___________________
Assessor Name: ____________________________ Phone: _____________________
Revised: 12-12-11
Insurance Information
If a patient has a PPO, PFFS, or HMO, then it’s a primary insurance. Medicare Advantage is a
Medicare Part C plan. In this case fill out all the information requested in the left hand block, and
include the Medicare Claim number from the Medicare Card even if they don’t use it. If they are just
Medicare, then we don’t need the address. We don’t need the address for Medicaid either.
We currently accept dual eligible`s (Medicare/Medicaid) and will soon allow Medicaid only patients.
If the patient is not Medicare eligible, complete their insurance information and ask them about any
deductible they may be aware of. We will contact their provider before proceeding with the order and
notify the patient if there is any out-of-pocket expenses involved.
HCPCS codes and descriptions are the codes for the products that you are ordering and the basic name
for the products. You must fill in the quantity. Remember only one type of product may be ordered for
each body part. You may not order 2 different types of knee, back or hand products. The sizes are based
off of your measurements of the patient as demonstrated in the measuring guide inside your manual.
Specify left or right or both by circling lt & rt. If they only have one side of their body affected, only mark
for the appropriate side.(use inches when measuring and avoid using sizes like sm., med. Lg.)
Billing Intake Sample
BILLING INTAKE FORM Assessor
FAX TO: 866-686-7881 SS Medical Supply Name:
Phone:
PLEASE PRINT LEGIBLY!
PATIENT NAME: LAST: FIRST: M:
______________________________________________________________________
DOB
MALE FEMALE
HEIGHT WEIGHT
Emergency Contact:
________________________________________________________________________
’ ” LBS
*PATIENT ADDRESS per MEDICARE DOES THE PATIENT HAVE AN OUT OF STATE
________________________________________________________________________
ADDRESS? YES NO SHIP TO:
_________________________________________________________________________
STREET: STREET:
CITY: STATE: CITY: STATE:
ZIP: PH: ALT PH: ZIP: PHONE:
PHYSICIAN INFORMATION *** NPI NUMBER OBTAINED AT www.hmedata.com ***
NAME: DX: DX: DX: DX: DX:
STREET:
CITY: STATE: ZIP:
PHONE: Fax: NPI:
INSURANCE INFORMATION. IF MEDICARE ONLY, ALL WE NEED IS MEDICARE NUMBER
Always fill in Medicare Claim Number to the right, don’t forget
the letter after the number!: MEDICARE #:
PRIMARY INSURANCE (ONLY IF Medicare Advantage, PPO,
PFFS, or HMO) What type is it? FILL IN EVERY SPACE Secondary/Supplement/Medi-Gap/Medicaid/Tricare
PHONE# of INS CO: PHONE #:
NAME of INS CO: NAME:
ADDRESS: ADDRESS:
CITY: CITY:
STATE: ZIP: STATE: ZIP:
MEMBER ID #: ID #:
GROUP or Policy#: GROUP#:
:
PLEASE FILL IN EACH ITEM AND SIZE ORDERED BELOW:
HCPCS CODE/ DESCRIPTION
QTY
SIZE
LT/RT
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Item Code is HCPCS Code listed on Patient Assessment Sheets, Include Description and Size (S, M, Lg etc.)
Revised 12-12-11
CMN`s or RX`s
(Reference completed sample forms)
These forms are optional for you to fill out. We prefer to do them for you. The only time it is suggested
that you do them is when the applicant is going to visit their doctor within the next few days and they can
or you can “walk in” the prescription to the office.
Fax Cover Page
(Reference completed sample forms)
Complete this form and fax it with every order. The Patient’s name, date of birth and phone number is
required. The Doctor’s name, phone and fax number are required. Date is the day you faxed it in not the
day you wrote the order. Check off the appropriate boxes and indicate at the top whether or not it is
coming with RX`s or if you need the RX`s done by the office.
Fax Cover Sample
SS MEDICAL SUPPLY
Durable Medical Equipment Prosthetics Orthotics Supplier
501 S, Falkenburg Road, Suite E18&19, Tampa, FL 33619 Office. 800-657-4090 Fax: 866-626-7881
New Order : SS Medical Supply Fax Cover Page: Needs Rx___ OR Complete w/ Rx__
Assessor name:
Patient Name
Assessor Phone:
Patient Phone (______) ______-________
E-Mail
Patient t DOB ____/____/________
Physician :
Physician
Phone: (______) ______-________
Fax: (______) ______-________
Fax To: 866-626-7881 One Order Per Fax!
***i.e. If you have 5 patients, send 5 faxes!***
Date faxed: ______/______/________
New Prescription Order contains a minimum of 4 pages including this Cover Sheet:
1. Patient Assessment Form(s) w any notes
2. Billing Intake Form Ensure you have accurate and complete billing information!
3. Signed Patient Consent Form
________________________ has called Physician’s office and has received their
permission to fax a DME request for the above patient
Send fax attention to:_____________________
Optional for Rep to obtain, but mandatory to complete order:
Physician’s Prescription forms signed (CMN’s) (optional, we will do for you)
Patients Clinical or Progress Notes from the Physician (optional, we will do for you)
Revised 12-12-11
The Most Important part of the order
Have the patient call their doctor’s office while you are there(if possible) to alert the office staff
telling them they will be receiving a fax request for DME for their chronic joint pain or appropriate
condition. Let them know that this is covered by Medicare and qualified beneficiaries will have
no out-of-pocket expense. We need the request “signed and diagnostic codes indicated”.
Then fax the forms back ASAP so the patient can begin to use these products for pain relief.
Note: Be sure and get the name of the person you are speaking to and reference it on the order.
This will insure that this person was your contact in case you need to follow up.
Also ask for the Doctors “NPI number”. This is required and can also be found by going to
www.hmedata.com . Save yourself time and ask for it and include it in the physician information
section. Be sure and get their proper fax number also. Some Doctor’s have several offices. Get the
correct one for that patient.
Then measure them for proper fit! Refer to the measurement chart in your forms package for
instructions on how to measure, and then write the measurements in inches. Each product and
supplier has different measuring requirements. Be sure and follow the correct procedure to insure a
proper fit. (If a patient gets the wrong sized product they may want to return it and not exchange it.
Therefore you would forfeit that order and commission. Take your time and measure correctly.
The Order Flow Process
1. Fax in at minimum: Patient Assessment sheet signed, Patient Consent Signed, the Billing Intake, all using
the fax cover page in our forms package.
2. Orders are screened to ensure we can read them with all the required paperwork is included, and all the
information is complete.
3. Sent to entitlement: We check the patient information on the billing intake against what it says in the Medicare
Database. If any of this, including the date of birth doesn’t match, it will be rejected as an entitlement error .Verify
your DOB with drivers license. This is the most common entitlement error, the second most common is the
address –make sure you have the address Medicare says that the patient lives!
4. Verify Insurance, and sometimes obtain a pre-authorization if insurance is an HMO or PPO. HMO’s are the
most difficult because we, as a provider, may be considered out-of network and therefore covered with a
deductible. (If this occurs we will notify the patient before we ship)
5. Send the RX by fax to the Doctor. If we do not receive the rx within 7 days our office will call your patient on
your behalf and ask them to call their doctor to find out what is holding up the order.
Order Flow Continued
7. Once we received the CMN (rx) by fax from the Doctor, we then ship the product directly to the
patient normally within 24-48 hours.
8. Once we receive a delivery confirmation from UPS or the Post Office, we will then bill the proper
entity for the product.
9. If we are billing Medicare directly, as the primary, they pay or deny within 28 days. Private Insurance
(Medicare Advantage), normally takes anywhere from 28 to 40 days to pay. Many companies reimburse
at different rates. Some HMO and PPO plans will require a 50% co-pay from the patient. We will
determine in advance whether or not to proceed with those orders. The last thing we want is to surprise
the patient with a bill.
Order Flow Continued
10. After we receive payment (Reimbursement), then commissions are paid.
AVOID the following Healthcare Providers as they continually decline, or do not offer out of
network benefits. Generally avoid smaller regional HMO’s/PPO`s because they tend to try and
avoid paying DME claims.
We have also had negative experiences with the companies listed below.
Arcadian Health (affiliate of SE Community Care)
Care Plus
BC/BS Medicare Advantage ( if we are considered out-of-network with them meaning we are not
located within a 30 mile radius of the patient, that patient will incur a $2,700 deductible and no one
will be paid a commission)
The Pipeline Principal
Remember also that you are building a pipeline with the orders you submit. Realistically you can expect
a 10-20% drop out rate due to doctor’s not ever signing the forms or the client’s insurance refusing
payment. However, the 80-90% you do get will make you a very good income. Keep your pipeline full.
We have a dedicated person who contacts patients on your behalf whose orders are not progressing.
This is to remind the patient about their order and to get them to contact their Doctor and find out what is
holding up the process.
Keys to working with Doctor’s offices:
Once your client receives the product and you revisit them, have a thank you card ready and signed by
the “patient” to be taken to the Doctor’s office where you can meet the staff, introduce yourself and set
up future referrals from that office. Position yourself as the expert on DMEPOS. I can’t stress enough
how important it is to be working the Doctor’s offices that approve these products. They are believers
and are open to you helping their patients (your clients) This can be a gold mine.
The bottom line is, you now have something to offer all of your clients 365 days a year. There is no off
season for these products and you do not have to pick up any money from the client!
Summary
You now have all the tools necessary to help thousands of people finally get the pain
relief they have been looking for without using medications or “snake oil” treatments.
These products really do work when they are used. Be sure to follow up with your
clients from the time you take the order through the time they take delivery. Remember,
these are our “senior” clients. They will have “senior moments” and forget they even
ordered these products. Remind them to expect a delivery and accept it when it comes.
Revisit these patients and be sure the products fit. Each time you revisit your client you
are solidifying that you care. Ask for referrals. You will be amazed! Besides those types
of referrals ask them if they go to a “senior center” or even where they go to church. You
can ask to put a flyer in the church bulletin or even meet with the senior center director
and let them know what you have to offer their community members. Remind them that
this has “no-out-of-pocket” expense for the qualified beneficiaries.
Consultants Order Status Spreadsheet
A “Gmail” account is required to access and share documents. You are able to view your order status in real time and
track your commissions as well.
(This example is missing the “patients name”, “consultants name", insurance and order date for privacy purposes)
Rx received from
doctor
Approved
Denied
1 script approved
7/13/2011 L1832
re-faxed 9/28/11
7/20/2011 1 script L0631
9/13/2011
Shipped
7/13/2011
Commisson Date
8/12/2011
Check #
Amount
2037
82.27
7/20/2011
8/26/2011
2054
91.02
6/3/2011
6/30/2011
1119
164.54
6/3/2011
6/30/2011
1119
164.54
7/7/2011
8/6/2011
2028
61.07
doctor denied scripts
re-faxed 9/28/11
1 script approved
6/3/2011 L1832
3 scripts approved on Medicare review
5/17/2011 L3908,L1832,L0631 Payment HELD
1 script approved
6/3/2011 L1832
1 script approved
7/6/2011 L1832
L0631,L3980
5/10/2011
dx denied scripts sts
he has not seen pt
since 1/11 & he
needs to see his
PCP on this
5/26/2011 L1832, L3631
on Medicare review
Payment HELD
5/17/2011
5/26/2011
Letter of Hardship
Be sure and have every patient sign this form with their order. 95% of the patients you encounter will qualify for
“hardship”. This means based on any of the factors below, this patient can not afford to purchase or pay a 20% co-pay
for the devices you are recommending. We in turn will accept whatever is paid by their carrier as full payment . Keep
this form for future reference. Do not fax it with the order.
SS MEDICAL SUPPLY
P. O. Box 89264
Tampa, FL. 33689-0404
Toll Free: 1- 800-657-4090, Fax: 1-866-626-7881
[email protected]
Form: Hardship Letter
Rev. 10/2010
Letter of Hardship
We are requesting that you review your financial situation to see if you qualify for any
workout options. Please advise if you have any difficulties making a payment or
paying off your balance because of financial difficulties created by any of the following:
_____ Unemployment
_____ Damage of Property
_____ Reduced Income
_____ Military Service
_____ Divorce
_____ Incarceration
_____ Separation
_____ Medical Bills
_____ Business Failure
_____ To Much Debt
_____ Job Relocation
_____ Death to Spouse
_____ Illness
_____ Death of a Family Member
_____ Pay Decrease
_____ Other (Please Specify)
Date of Difficulty: ______________________________________________________
Do you believe that your situation is temporary or permanent? ___________________
Please give a brief explanation of why cannot make a payment: _________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
I state this information is true and correct to the best of my knowledge.
______________________________ ______________________________
Patient Print Name
Patient Signature / Date
Patient instructions for calling their Doctor`s office
While the representative is still with the client/patient, call the doctor’s office that has treated them
for their particular ailment (joint pain, arthritis, diabetes, etc.)
Be sure and have the patient speak to the nurse and explain what they are requesting.
If they get a recording and must leave a message do so and explain what they are requesting.
This works best if the rep gets on the phone also with their permission, and explains what the
person is requesting as well as what the office needs to do. Get this person’s name and write it in
the notes section of the assessment form and also attention too, when faxing the RX`s.
The client/patient says:
This is ____________________.You will be receiving a fax requesting for some durable
medical equipment for my chronic pain. Please sign and code them and fax them back to SS
Medical Supply as soon as possible. Thank you.
FAX: 866-626-7881
Do this with every client/patient and also leave it with them.
Telemarketing Script for calling members for DME
Hello Mrs.__________ my name is _______________and I'm conducting a customer service call regarding your
Medicare coverage.
My records indicate that you are covered under ______________.
I am pleased to let you know about some additional benefits that are available to you at no additional charge. I
just need to ask you one question to see if you qualify for these benefits.
Do you now or have you ever had any joint pain or any type of arthritis?
Mrs. ________, I am happy to let you know that there is a non-pharmaceutical way to greatly reduce your joint
pain with the use of Medicare approved orthotic devices. These devices require no out-of-pocket expense to
qualified individuals.
Mrs. ________, all I need to do now is come to your home and do an assessment of the areas that you are
experiencing pain in and fit you with the proper orthotic device. The whole process will take less than 30 minutes
and you'll be on your way to getting the pain relief that you deserve.
I'll be in your area __________ of this week. Is 10 am or would 1 pm be better for you?
Thank you Mrs., _________ I look forward to helping you on ________ at _____.
There are no out-of pocket expenses for those who are qualified to receive these products. This is a great
business builder by itself and those who use the products will swear by them and the referrals just keep coming.
Turn around time is 28 to 40 days for reimbursement (your payday).
Example of an average order: L1832 knee (2), L0631 back
Commission= $276
2 orders per day, 4 days per week = $2208
3 orders per day, 4 days per week = $3312
(Commission example is based on the top tier production and may vary based on your contract level.)
I look forward to your success!
Leonard Peel
National Sales Director
SS Medical Supply Inc.
843-847-1567
[email protected] or [email protected]
Presentation Books, Brochures
and Sample Supplies
Presentation books can be created at no cost by using PDF`s that are sent to each consultant via email. The forms will be attached
and all you need to do is print them and add them to a small 3 ring binder with sheet protectors.
Tri-fold company brochures and matching business cards are also available and can be purchased through www.gotprint.com in
various quantities. I highly recommend these for enhancing your professional image.
Sample products (knee and back braces) are also available and HIGHLY RECOMMENDED! Letting people see and feel these
devices is a very powerful sales tool.
The cost for 1 knee = $35. The cost for 1 back =$35. This includes shipping to your residence.
Payable to: LP Wealth Management Enterprises
2376 Bergeron Way Mt. Pleasant, SC 29466
Many company brochures are available and will be distributed mainly by PDF. Actual brochures will be available upon request and
distributed through many local agencies. If you are not affiliated with any agency, please email [email protected] or
[email protected] for further assistance on any matters pertaining to DMEPOS.