Now with the DMEPOS Bidding program's re-bid rates, the reverse is true.The old rationale behind the program is no longer the case, as the proposed reimbursement rates Medicare intends to pay the Round One lowest bidders are 50% to 60% lower than what can be purchased from the largest chain pharmacy stores or their discounted online websites.

Ranked #32 in the Fortune 500, Walgreens, the largest chain pharmacy in the world, sells some DME items in their stores and online including walkers. Their location in North Miami Beach, Florida is running a current "Sale Special" on folding walkers without wheels for $89.99. You can actually purchase a similar walker on Walgreens.com for the same price which ships in 4 business days and takes an average of 9 days to arrive at your door.

 

 

• Trained intake staff records the physician order. They input the patient's information using patient management software.

• A call is made to Medicare's Interactive Voice Response system (IVR) to verify the patient's Part B eligibility and checks to see if the patient has had the same or similar equipment within the past 5 years. This process takes about 15 minutes.

• Staff  must collect and evaluate documentation from the Doctor including: the diagnosis, length of need, doctor's signature, and doctor's notes stating that there is no alternative for the patient's "daily living" other than the walker, and proof that the patient can use it properly.

• A trained Delivery Technician must drive to the patient to deliver the item.

• The Delivery Technician must adjust the walker to properly fit the patient. Joint Commission accreditation standards require that the Delivery Technician evaluates the patient's living environment. They must also train the patient on slip and fall prevention and must document that the patient has been properly trained on how to use the item. The equipment's model and serial numbers are recorded in case of manufacturer recalls. Additional required documents include explanations about warranties and an option to rent or purchase the item.

• The Delivery Technician must review with the patient the company's Notice of Privacy Practices, their Medicare Complaint Policies and Medicare's 26 Supplier Standards. Additionally, the patient fills out and signs a Blanket Assignment Agreement which gives the supplier the authority to bill and collect reimbursement from Medicare. All documents must be signed to prove that they were received. All of those forms must be saved for at least 5 years.

• When all the paperwork is collected, the billing department enters all of the data from the delivery.  Medicare is then billed using approved billing software, which typically requires ongoing usage fees.

• The company then waits to be paid 80% of the claim by Medicare, which typically takes 30 days. If the claim is randomly chosen for an audit it may take 6 months to a year to be paid. Once Medicare pays the claim, if the patient has a secondary insurance policy, the company can bill the secondary insurance for any possible co-payments or deductibles.

• If paid, the chart can be audited at any time over the next 4 years and the $40 for the walker may be taken back by Medicare.