This article originally appeared in the September 2020 issue of HomeCare Magazine.
Home medical equipment (HME) providers offer vital, lifesaving equipment and supplies to patients with respiratory diseases and sleep disorders. These patients require new supplies on a regular basis. A recent study by ResMed suggests a growing trend: Sleep therapy patients are more likely to cease treatment within a year unless they subscribe to a resupply program.
Resupply programs provide regular replacements of HME essentials such as positive airway pressure (PAP) masks, tubing and filters to ensure that patients’ devices are clean and working properly. They also benefit providers’ bottom lines. Now, in the middle of the COVID-19 crisis, resupply programs can reduce person-to-person contact, thus saving the lives of providers and patients alike. Here is some guidance on how to manage resupply programs for sustainable provider and patient success.
Resupply programs have long been a cornerstone of successful HME companies. Why, then, is it often difficult for patients, providers and referral partners alike to navigate these programs? The answer takes us back to resupply’s first steps.
A physician or clinician first diagnoses a patient with sleep apnea, for instance, and refers this patient to an HME provider that fulfills the initial order: PAP mask, headgear or chinstrap, tubing, filters, humidifier and water chamber. During this diagnostic visit, the doctor should discuss enrolling in the provider’s resupply program—a step that the doctor may either fail to mention or the patient can miss in the flurry of information.
Yet the benefits of resupply programs are many. Enrollment prolongs treatment, creates better outcomes and increases patient compliance. It also boosts revenue for providers and physicians.
There is a drawback: As orders increase, providers may struggle to manage too many processes with too few resources. In turn, they might explore external options, including automated software or outsourcing resupply to third parties, in order to save time and build more efficient resupply programs.
What, then, are specific ways for providers to better manage their resupply programs? Here are some best practices for strong resupply programs.
Providers who reach out to new patients quickly ensure better compliance with resupply programs, including follow-up visits required by Medicare and many other payers. In addition, providers need to educate patients early about regularly replacing their PAP equipment and supplies. These patients may stay on treatment longer; use cleaner, more effective devices; and have supplies shipped to their homes.
Most insurance companies provide coverage for PAP devices. Yet regulations may vary.Medicare and Medicaid have different rules than commercial payers such as BlueCross BlueShield and United Healthcare. Rules differ around prior authorization, compliance and utilization—specifically, around the quantity and frequency of parts in the resupply cycle.
Education is crucial for creating strong relationships with your referral sources—that is, physicians, nurses and clinicians. Their daily schedules are likely filled with back-to-back appointments, leaving little time to talk with pulmonary and respiratory patients about their resupply options. In addition, you may need to provide reminders about annual visits, yearly prescriptions and patient compliance.
Should you ship resupply items from your warehouse or as drop shipments from the vendor? Which brands should you offer your patients? Your margins greatly influence these decisions.
Due to PAP’s complexities, you need to create a formulary or table that identifies PAP products available by payer. In some cases, you can charge a premium for off-formulary items. There may be major variances in margin depending on the make and model of a PAP device. If a patient has Aetna insurance and wants the new mask advertised on a television commercial, that mask is not likely to be on the table because Aetna’s reimbursement does not support it. You may be able to charge an upgrade fee or bill a non-assigned claim to support your margins while providing the patient with their desired mask.
Despite following these best practices, some providers still struggle to manage their resupply programs. This is where a resupply outreach partner comes in. These solutions streamline the resupply experience for providers and patients.
For providers, partnering with a resupply outreach vendor saves time and money, aids in patient compliance, reduces paperwork, and increases revenue. Patients also see benefits. They receive frequent, ongoing communication with a sleep or respiratory coach who understands their disease and helps them navigate their supply options. In turn, patients prolong their treatment, which sets up providers for sustainable resupply success.
Sometimes, providers are unable to manage the high volume of orders, causing delays and frustration for patients and physicians. Providers may pause their resupply programs as a result to give themselves time to catch up. For providers needing extra help, there is a smart solution: outsourcing. HME billing and outsourcing companies offer solutions for processing resupply orders.
These solutions fill the gap between resupply outreach and resupply order fulfillment, with outsourcers taking resupply orders and processing them using the provider’s methods. Typically, this includes resupply order entry, documentation review, electronic documentation requests and follow-up; eligibility verification and prior authorization; and verifying that orders are paid before advancing them in the workflow.
Be proactive yet smart as you reach out to your physician partners. Set reminders to contact them for renewal prescriptions on active resupply patients at least 30 days in advance. In turn, these physicians can schedule follow-up visits with their patients. Share outcome data and keep physicians informed throughout the process.
Now you have the tips and tools you need to better manage your resupply program—or to build a smart resupply offering from scratch. The key is creating sustainable change.
Prochant is the leading reimbursement firm with a dedicated focus on HME and pharmacy. We have a proven track record of helping HME and pharmacy providers meet their financial goals. Our scalable solutions, years of experience, and advanced technology provide best-in-class results to the healthcare community. Headquartered in Charlotte, North Carolina, our client base includes national HME and pharmacy providers and health systems.