Hospice fraud is a growing problem, particularly in four states where reports show an increase in poor-quality care and providers enrolling patients who don’t qualify for hospice. New laws emerged, but it's enough of a problem that new CMS regulations propose more oversight to help fight unethical and illegal practices.
DME billing is one key concern within hospice compliance, and government Medicare audits show that CMS improperly paid out $187.5 million in DME payments. The audit found mostly coding issues that led to billing errors and DME vendors supplying equipment to patients without a proper hospice care provider.
This rise in noncompliance, waste, and heightened oversight means hospice practices must pay closer attention to common red flags and focus on proactive DME management.
DME audits may come from a few common compliance issues and mistakes, from missing documents and conflicting pricing to delivery delays and inaccurate billing.
DME hospice regulatory requirements have clear document guidelines and require complete DME orders. Details depend on the type of DME but include information like:
With missing order information, your documents don't meet CMS criteria and may lead to denial or scrutiny on an audit.
Problems with vendor pricing, from overcharges to conflicting fees, may lead to noncompliance, and some of these practices may be classified as fraud, abuse, or waste and result in fines. For instance, overcharging might include billing for supplies or equipment the patient doesn’t receive. This might look like inconsistencies in the number of units billed versus received.
Another might be charging for more expensive equipment when the patient only received basic or standard, known as upcoding. Higher prices for the same or similar equipment from different vendors may also suggest overcharging or questionable practices.
Additionally, equipment delays are a major billing and compliance problem. CMS requires proof of delivery on orders, so delays may throw off the documentation and billing process, leading to mistakes. If you receive DME bills and submit a claim before the patient gets the items, you’re essentially submitting a false claim. You end up billing CMS for items the patient hasn’t received, which will cause problems in an audit.
The good news is that focusing on vendor selections can infuse hospice best billing practices into your business and encourage better compliance. A DME network, for example, offers a variety of suppliers but with standardized documents, pricing control, and better tracking.
Using multiple vendors without a standard workflow or documents means everyone works from random forms. You’re bound to find gaps and miss key data on ordering and delivery. However, a DME manager gives you access to a standardized process that simplifies ordering and documentation.
Everyone uses the same form and system, which means the data fields and ordering and delivery processes are the same. The consistent workflow reduces errors and enhances billing, saving time and improving accuracy.
Sometimes, hospices decide to stick with one or two DME suppliers to simplify the DME process. However, there is very little control or flexibility, and you may notice high costs and mistakes that impact your billing. A vendor network eliminates these issues.
For instance, a DME manager like Qualis handles the back-end details of DME suppliers, negotiating contract terms with volume pricing, so you don’t have to worry about those details. You gain better pricing control and avoid high-risk audit issues, like overcharges or upcoding.
A busy hospice practice might review hundreds of invoices for different equipment and supplies in a month. Finding each of those across multiple vendors can be an overwhelming and time-consuming task.
With a DME vendor network, the standardized workflow and advanced software with automated tracking offloads all this extra work. You can prevent the frustrating search for missing invoices and make sure you're not paying for undelivered or used DME.
The best way to pass an audit is to stay compliant before you ever get there. Qualis DME management and ordering solutions give you the supplier oversight you may not have time for and simplify invoicing with real-time tracking for enhanced compliance.
Qualis negotiates contracts and preferred pricing behind the scenes and continually monitors activities of over 900 DME providers. We take a proactive approach and look at every order, pick-up, and note for potential issues. If we notice anything that could lead to noncompliance, we step in and solve it before it becomes a problem.
Qualis DME+ ordering solutions track DME status, from order to delivery and invoicing. Follow order and invoice progress and receive a consolidated invoice at the end of the month. These invoicing features simplify paperwork, eliminate billing overwhelm, and increase accuracy for your financial team.
Understanding your DME vendor workflows helps you identify high-risk areas that may open you up to noncompliance and hospice audits. A DME management expert like Qualis reviews your current DME process and offers strategies to control costs and improve billing practices for better compliance.
Schedule a risk-free consultation to explore DME evaluation.