Durable Medical EquipmentProsthetic 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: • Alleviate their pain • Lower their dependency on drugs • Actually save Medicare and insurance companies money • 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 difficultbecause 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 SpreadsheetA “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)
Letter of HardshipBe 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 firstname.lastname@example.org 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@example.com@gmail.com
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 firstname.lastname@example.org email@example.com for further assistance on any matters pertaining to DMEPOS.