Page 28 - HME Business, October 2017

STUDYING REVENUE QUALITY
Wayne Slavitt, founder
and CEO of Mobül:
The Mobility Store
Slavitt is a retail crusader, and with good reason: his mobility business in Long Beach, Calif. Is 100 percent retail sales. There is not funded portion of his
revenues. And he does that for a reason that he thinks more HMEs should study: Revenue quality.
“As business owners looking at the upcoming year, they should be looking at the quality of their revenues,” he says. “Where are the revenues gonna come from? What is going to happen to margins? How predictable are those revenues going to be in the future?”
And there’s a reason that Slavitt wants providers to think in these terms: they need to
be more hard-nosed about where their money is coming front. While many might have built their businesses around Medicare and patient funding, if they truly examine their revenues from a more straightforward perspective, they might not necessarily be too happy with what they see.
“If the prediction of those revenues is in
jeopardy ... then that doesn’t bode well for the upcoming year.
Furthermore, Slavitt says that providers shouldn’t necessarily look at their funded businesses with poor or no profits as ways to draw in retail customers.
“If you’re gonna program loss into your sales, then that’s no different than spending that money on marketing,” he advises, adding that providers should be “going after that right customer, as opposed to this accidental customer who’s coming in to take product off your floor through Medicare at no profit to you.”
TOUGH NEW AUDIT PILOT
Wayne van Halem, president and founder of The van Halem Group LLC
A major audit trend van Halem sees coming up is a special pilot program involving targeted pre-payment reviews. In the program, a given
provider will get 20 to 40 pre-payment audits, and they have to respond to those. If the provid- er’s claims are clean, then that provider will get a
six- to 12-month reprieve, he explains.
If they don’t perform well, then the provider
must undergo education sessions and will undergo 20 to 40 more claims audits six months later. If the error rates don’t improve, several things can happen, such as being referred to the UPIC for more targeted, in-depth claims audits.
“If at that time their error rate does not improve, then they’re going to get referred to CMS,” van Halem says. “With a referral to CMS, there are several things that can happen. One is they can be referred to one of the new UPIC contractors for them to do a targeted, more in-depth audit of the provider’s claims. Or, CMS can take a tougher tack.”
And that can get very serious, he says.
“CMS has the authority to revoke billing privileges of a provider who shows a pattern
of billing for services that don’t meet the requirements,” van Halem explains says. “They started putting information regarding their authority to revoke billing privileges in their overpayment letters about a year or so ago. So, just a bit, warning to folks that there’s a risk of that with these new types of audits.” n
26 HMEBusiness | October 2017 | hme-business.com
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