LAS VEGAS – Washington-based HME providers Diana Hudack, CPB, and Shelly Lopez-Zacapu, LRCP, went into retail a couple of years ago, mostly out of necessity. “We had to do retail on the side,” said Lopez-Zacapu, a Medtrade Spring attendee who made the trip to Las Vegas from Puyallup Respiratory Services, Puyallup, Wash, “or we couldn’t make it in business.”
Looking to boost their knowledge of all things retail, they attended Aggressively Moving into the Retail Market While Avoiding Legal Pitfalls with Jim Greatorex (pictured), vice president, Accessible Home Improvements of America; Andrea Stark, reimbursement consultant, MiraVista LLC; and Jeffrey S. Baird, JD, attorney, Brown & Fortunato.
Stark told providers on day two at Medtrade Spring that they did not have to turn away patients, but instead could file a claim with ABN modifiers. “If patients are ready to give you that money,” she said, “there is no reason you should turn it away.”
“I have a different take,” countered Greatorex. “If someone comes in and it’s clearly going to be a cash transaction, and it’s an item that could possibly be covered by Medicare…They didn’t come in with a prescription and they didn’t come in with any intent to have this product covered by Medicare. To take it to that next level [with paperwork] really ruins the customer transaction.”
Greatorex maintained that there was little risk in keeping the purchase a clean cash transaction. “The issue of Medicare actually doing something drastic to you is very small,” he said.
As the only attorney in the room, Baird interjected: “It’s a classic risk/benefit. The number of times you’re going to get popped for something like that would be pretty rare, and even then it only means you would have to repay some money…From a legal standpoint, Andrea Stark is correct. Andrea is saying is that you can cover the documentation requirements in a way that does not take away from the patient experience. As you go into retail, you have to weigh that risk/benefit.”
For their part, Lopez-Zacapu and Hudack err on the side of caution. “We do ABNs for everybody,” said Hudack. “Howevever, I also see where it can dig into profit, because time is money.”
