- Stock & Bill
- Articles of Interest
Stock & Bill
BENEFITS OF STOCK & BILL
- Conservative Treatment Modality
- Passive Monthly Income for Healthcare Professionals using our Stock & Bill Program.
- NO Overhead or Cost for Inventory
- Braces Dispensed at Your Facility (Point of Service Treatment)
- NO Billing Concerns OR Scrutiny…We Handle ALL Billing for You!
- Monitored Patient Outcome (Patient’s Progress is monitored more efficiently)
- DME License Assistance Provided if Desired)
HOW DOES STOCK & BILL WORK:
- Facility receives ALL Bracing Inventory at absolutely NO Cost to them.
- Physician Diagnosis Patient with Bracing Indication.
- Physician Prescribes Desired Brace to Patient at Office versus Patient Driving to elsewhere for Brace.
- Patient is Fitted with Brace at Physicians Office.
- Patient Signs Form Acknowledging that they Accept Brace and Authorize Our Affiliate to Bill Their Insurance Company.
- Patient leaves Physician’s office with Fitted Brace.
- Bracing RX’s are picked-up at your office and sent in for billing.
- Inventory replenished 1/1 and shipped to Doctors Office.
Frequently Asked Questions
What is DME?
Durable Medical Equipment
What kind of braces do you provide?
We provide custom and off-the-shelf orthotics &; prosthetics (i.e. knee braces, back braces, wrist braces, joint, prosthesis, etc.)
What is Stock & Bill?
Stock and Bill is a service provided to Physician offices. This service allows a Physician to dispense a brace from their office without having to pay for inventoried product (s)-thus eliminating substantial overhead associated with braces.
What’s the advantage of Stock & Bill?
Patients appreciate the services and convenience of being treated and fitted by their Physician on the premises rather than driving and being treated by someone they do not know at a hospital or drug store. It also guarantees the Physician that his/ her patient will receive a quality device.
Is Stock & Bill/ Consignment Legal?
Stock and Bill/ Consignment IS LEGAL and is a normal business modality for many Orthopedic, Neurological Surgeons and other Healthcare Professionals today. However, there are rules and regulations to follow under Medicare Guidelines & OIG (Office of Inspector General). CEO of Rego International will be more than glad to set up an appointment to discuss and welcome you to consult your Healthcare Attorney if desired.
Note: Please see documents of interest under medical division.
Is it legal to for a Healthcare Professional to get compensated for dispensing out of our office…doesn’t sound as if it is?
Yes it is totally LEGAL if your medical specialty has indications for bracing. All guidelines are adhered to and must be followed. We will gladly provide you with all needed information and documentation.
Why haven’t I/ we been informed of this prior to your visit if it’s true?
Many times manufacturing executives do not focus on this aspect or modality. Most (not all) normal call patterns are to present the benefits of their product and services. Rego International is an independent company and presents both modalities; patient care and fair market value fitting fees (under the Medicare guidelines) for office revenue enhancement.
Who’s responsible for paying for the inventory that we’ll dispense from our office?
Our Bracing Affiliate (s) will supply your office with inventory at its cost throughout the length of the agreement; however, there are simple guidelines to follow. Rego International will provide you with a sample draft contract for review.
Who does the billing for the dispensing?
Our Bracing Affilate (s) understand your concern with security and confidentiality. Our Affiliate bill with THEIR PROVIDER number and NEVER YOUR’S. They accept most insurances and are CMS provider's and participate with virtually all insurances in Florida.
Are O&P items covered by my insurance?
Typically these items are covered by most insurance carriers; HOWEVER, normal deductible and co-insurance applies. Some insurance plans do not cover custom bracing, while others only cover custom bracing. Ultimately, knowledge of your individual plan's coverage is your responsibility.
Who is responsible for; servicing our account, maintaining the inventory and par levels?
We at Rego International have service executives committed to providing ultimate service for your convenience. We will organize your initial inventory, train your staff on fitting and necessary documentation for dispensing, as well as maintain your par levels in tact for the duration of our agreement.
Can patients be seen at home?
Unfortunately under normal circumstances we cannot facilitate such requests; however, depending on the nature of the brace or prosthesis or a particular patient's ambulatory condition, special accommodations can be made.
Supplied upon request
Supplied upon request
Articles of Interest
a) Laws/ OIG guidance on Stock & Bill/ Consignment closets
b) Pecos Delayed
CMS announced today that it will delay until January 3, 2011 the provider enrollment requirements under the Provider Enrollment, Chain and Ownership System (PECOS).
Facing overwhelming enrollment problems, CMS recognized that it was unable to implement PECOS on the scheduled implementation date of April 5, 2010.
AAHomecare has been working closely with CMS to raise awareness about troubling aspects of the program since the issue first arose in October 2009. AAHomecare met with senior CMS officials repeatedly to raise concerns about how this program would adversely affect Medicare HME providers and patients. In a formal letter to CMS, the Association also requested a lengthy delay so patient access to homecare would continue and provider cash flow would not evaporate when the program was implemented on January 5, 2010 – the date for PECOS implementation before the first postponement.
AAHomecare communicated with CMS officials several times per week leading up to the latest delay in order to keep CMS abreast of actual provider experiences and shortcomings of the PECOS program.
The Association also reached out to the American Medical Association (AMA) and the physician community to work cooperatively in order to obtain a delay in the program. An AMA representative said, “We are getting plenty of calls and emails from physicians saying they are not able to get through to customer service lines like PECOS if they have a question. There are long wait times to get through and general problems getting applications processed.” CMS stated on the call today that it plans to send a letter to all physicians who last enrolled more than six years ago to remind them to re-enroll in PECOS. The agency also said providers will continue to receive informational messages on PECOS, and CMS will make updates to the physician records periodically.
“PECOS is a classic example of the documentation and administrative burden that is part of doing business with Medicare,” commented AAHomecare President Tyler Wilson. “In many cases, the rules and regulations create almost impossible demands for filing claims. AAHomecare was a pit bull in fighting this issue through our contacts with CMS and I am glad to see the agency pull back from the brink of implementing such an impractical requirement.”
While the PECOS program has been delayed, HME providers will continue to see warnings on their claims because the PECOS enrollment process will continue. AAHomecare will push CMS to publicize PECOS requirements with physicians similar to the way it handled the National Provider Identifier (NPI) number issue. During the NPI start-up process, CMS was sending out public announcements several times each week.
AAHomecare Vice President for Government Affairs Walt Gorski said, “Ideally, we would like to see some sort of requirement that ties physicians to the PECOS enrollment process. Their claims were not in jeopardy, but ours were. The burden should not be placed on the HME provider to press physicians to enroll. Nevertheless, this is an excellent outcome.”
Gorski added, “We greatly appreciate the work of the AAHomecare State Leaders’ Advisory Council for developing a PECOS survey to document the extent of the PECOS problems. The delay of implementation of PECOS edits and claims rejections demonstrate the importance of advocacy and action within the home medical equipment sector and also the value of collaboration with other health sectors.”
AAHomecare in Action . . .
Walt Gorski and Stacey Harms, vice president and manager of government affairs for AAHomecare, respectively, held two calls with the CMS Program Integrity staff to discuss consignment closets, PECOS, and the OIG fraud and abuse studies…. Jay Witter, senior director of government affairs for AAHomecare, attended the House Ways and Means Committee hearing for the FY 2011 Budget…. Alex Bennewith, senior manager of government affairs, held a medical supplies council call Thursday to discuss diabetes and negative pressure wound therapy issues…. Jay Witter met with an AMA lobbyist to discuss health care reform…. Stacey Harms discussed oxygen reform with staff of Representative Mike Ross (D-Ark.).
Ohio Telephone Press Conference Airs Downside of Medicare Bid Program
AAHomecare’s public relations firm, Rational 360, worked closely with the Ohio Association for Medical Equipment Services (OAMES) to organize a telephone press conference for the media on February 4. The call focused on the harmful impact of the bid program for patients and providers in Cincinnati and Cleveland, Round One bidding areas.
Speakers on the call included Congressman Tim Ryan (D-Ohio) who is a cosponsor of Rep. Kendrick Meek’s bill, H.R. 3790, to eliminate the bid program. During the call, which attracted participation by national and Ohio journalists, Congressman Ryan commented, “Competitive bidding sounds good, but it will only reduce access to care, choice, and quality of care for thousands of homecare patients. With the economy just starting to recover, now is not the time to adopt ‘competitive’ bidding, which will kill jobs and small businesses.”
Thirteen out of the 18 members of Ohio’s House delegation have cosponsored H.R. 3790, and numerous disability groups support the bill as well, including the Cerebral Palsy Association of Ohio, the Ohio Society for Respiratory Care, and many groups such as the ALS Association, the American Association of People with Disabilities, International Ventilator Users Network, Muscular Dystrophy Association, National Emphysema/COPD Association, National Spinal Cord Injury Association and Post-Polio Health International.
J.D. Jones, a 49 year old Medicare patient with pulmonary hypertension who participated in the call, described the personal threat posed by competitive bidding to patients: “When we had a blackout in 2007, I called my homecare provider and was able to rely on him for batteries for my ventilator and other home equipment devices to keep me going during the outage. Under competitive bidding, I would have had to put calls in to several different providers during an emergency, none of whom I know or trust.”
Also joining the call to speak out against the bidding scheme was John C. Reed of the Cincinnati-area HME company PRO2 Respiratory Services and Joe Petrolla and Anthony LaCute of Seeley Medical.
Among the stories that resulted from the call was a segment broadcast on an ABC affiliate in Youngstown
c) Rescended law
Consignment Closet Rule Rescinded
A CMS official alerted regulatory stakeholders Monday night that the “consignment closet” rule, scheduled to take effect in March, has been rescinded to allow for further review and consideration. The agency is considering rulemaking to address this issue in the future. This means that the current rules governing consignment closets under Medicare are still in place.
VGM Group’s Mark Higley, who sits on the AAHomecare regulatory council, attended a meeting in Washington this week. Kimberly Brandt, CMS’ Program Integrity Group director, released an email that included “I just wanted to give you a heads up that instruction was given to the contractors this evening and the 'consignment closet' CR has been pulled-back to allow us to further review the issue and consider other implementation dates. We are considering rulemaking to address this issue in the future, but no official decisions on that have been made at this time.”
The consignment closet policy outlined by CMS in a transmittal issued in September 2009 would have essentially prohibited arrangements where an enrolled supplier of durable medical equipment, prosthetics and supplies (DMEPOS) maintains inventory at a practice location which is not owned by the enrolled DMEPOS supplier, but by the physician, non-physician practitioner or other healthcare professional. The rescinded rule would have required physicians (physician or non-physician practitioner) to take possession of DMEPOS items who then would have had to bill for the equipment using their own supplier billing number. In addition to being impractical for physicians and Medicare beneficiaries, such an arrangement would have likely violated the physician ownership and referral statute--known as the Stark law.
Dennis Clark, CPO, president of OPGA, commented, “For those of you successfully managing consignment closets, this is great news. We're happy to keep our membership informed on changes to consignment closet rules.”
The regulatory council worked closely with CMS officials over the past several months explaining why the rule would have created serious disruptions in services for Medicare beneficiaries
(Portion of November Regulatory Council minutes)
Action Item: Regulatory Council to establish a workgroup to review consignment closet policy and make a recommendation to the Council on an alternative consignment closet proposal. Workgroup will develop a list of DME items to be included in consignment closet recommendation. Workgroup will include Mark Higley and Anthony LaCute as well as HME/RT Council members. Workgroup to consult with other interested parties to develop a compromise alternative to recommend to CMS.
(Comments submitted to CMS officials)
AAHomecare is very concerned with the implications and application of a new policy regarding compliance standards for consignment closets and stock and bill arrangements, Change Request 6528/Transmittal 300, which is slated to be implemented on March 1, 2010, following a six-month delay in the effective date. The new policy would forbid any "stock and bill" arrangement where a DMEPOS supplier has inventory in a physician's office and where the physician furnishes these DMEPOS items to a patient while the supplier bills for it. For purposes of this discussion, we will call these types of arrangements, "convenience closets." Convenience arrangements should be viewed differently than "consignment closet" where a physician has a contract with a manufacturer of DMEPOS, takes ownership of the DMEPOS item and bills for it using his or her own supplier number.
We recognize that the new policy is aimed at eliminating patient confusion, ensuring suppliers are accountable for inventory that they bill that is furnished through a convenience closet arrangement with a physician's office, and ensuring a greater measure of control so that the beneficiary knows who he/she should contact with any questions or problems with the DMEPOS item.
However, it is not practical to eliminate this policy in its entirety, and we believe that new DMEPOS requirements that have gone into effect since the original September 2009 effective date for the consignment closet policy mitigate the concerns that precipitated the policy change. Further, it is not practical to require all physicians to obtain a DMEPOS supplier number and bill for these items. Implementation of the new consignment closet policy will sever the continuity of care that currently exists between the patient, physician, and DMEPOS supplier under theses scenarios.
Accreditation is now mandatory, meaning that suppliers must comply with all of the DMEPOS quality standards, which hold suppliers to a higher level of accountability. These standards include providing proper instructions on use of the equipment as well as providing contact information and phone numbers for regular business hours and after-hours access, equipment repairs and emergency coverage. Accreditation requirements should be sufficient to ensure that DMEPOS suppliers are accountable for any item that they bill, and the accreditors should be able to monitor compliance with the quality standards. By virtue of the fact that all suppliers who bill Medicare are accredited, this means that they are in compliance with Medicare enrollment standards, supplier standards, quality standards and the surety bond requirement. Medicare suppliers should properly fill out the Medicare supplier enrollment form (855s) and be only allowed to bill for items for which they are qualified to provide, and CMS is in the process of implementing edits to verify that suppliers are accredited to provide any DMEPOS items/services that they bill.
If implemented, the new consignment closet policy will jeopardize beneficiary access to medically necessary DMEPOS items that are furnished to a patient in a physician's office for the convenience of the patient to ease their transition to the home setting. Patients will be forced to travel to a separate location that could be across the street or miles away to fill the physician's order for home medical equipment or may be forced to wait even longer to coordinate delivery of the DMEPOS item to the beneficiary's residence. It seems senseless change the current policy and force patients to travel to obtain home medical equipment or delay access to items and services.
Additionally, physician practices generally cannot bill for DMEPOS items provided to their patients under the physician self-referral law (Stark Law). Physicians are permitted to bill for only a limited number of DMEPOS items under the in-office ancillary services exception to Stark Law. CMS has determined that the Stark Law exceptions for DMEPOS items are canes, walkers, crutches, folding manual wheelchairs, and blood glucose monitors. DMEPOS suppliers currently stock inventory in "convenience closet" arrangements in physician offices that cannot be billed by a physician including: portable oxygen tanks, nebulizers, CPAP devices, and TENS units. These are all items that exist in physicians offices to promote timely treatment of patients. Patient access to care would be jeopardized under the new consignment closet compliance standards because these items could no longer be provided to a patient in the physician's office without Stark Law violations occurring.
AAHomecare recommends that CMS immediately withdraw new policy regarding compliance standards for consignment closets and stock and bill arrangements because it will create patient access problems and because several policies have gone into effect that alleviate the Agency's concerns with "convenience closet" arrangements.
If CMS does not withdraw the policy completely, we request that the policy be rescinded and that the Agency utilize the full rulemaking process to allow for an appropriate public comment period and consideration of comments by all affected parties before any policy is finalized. We feel that the process for releasing the policy changes was inappropriate. The new policy is a drastic change from the existing policy, yet it was released in a Change Request rather than through rulemaking, and DMEPOS suppliers and physician practices were given less than a month to comply before the effective date of the policy.
Even with the six month delay in the effective date, there has not been enough proper education of physician practices, and we believe that many are unaware that they may need to obtain a DMEPOS supplier number, accreditation, and meet other requirements to continue providing DMEPOS items to their patients. Due to the short timeframe and challenges with Stark (which we believe the OIG is looking into this year.) we further believe that CMS must appropriately review the various types of arrangements between physician practices and DMEPOS suppliers that stock inventory through arrangements with physician practices and consider the effect on each type before any change in policy is effective.
*Consignment Closets Stay Open
Feb 8, 2010 11:23 AM
BALTIMORE—In an instruction to its contractors Feb. 3, CMS rescinded a new consignment closet rule for further review. The agency said it was considering rulemaking to address the issue in the future. That means, according to AAHomecare, that the current rules governing consignment closets are still in place.
In a report last week, the association said the new consignment—or loan—closet policy, which had been scheduled to take effect March 2, would have "essentially prohibited" an HME company from maintaining inventory at a practice location owned by a physician or other health care professional.
According to the association, the rule would have required physicians or non-physician practitioners to take possession of DMEPOS items and then bill for the equipment using their own billing number. "In addition to being impractical for physicians and Medicare beneficiaries," AAHomecare said, "such an arrangement would have likely violated the physician ownership and referral statute, known as the Stark law."
The association said it had worked with CMS officials over the past several months to explain why closing down the closet arrangements would have created serious disruptions in services for Medicare beneficiaries
d) Supporting Legal Documentation