How to marry reimbursement with cash sales is a must in today's environment. Allowing patient choice with a properly executed ABN enhances the patient's knowledge of your business and potentially builds revenue. Diversifying your book of business will keep you healthier to weather shrinking profit margins.

1. (c) Lieber/Weil2008
Compliance, Cash andCompliance, Cash and
Reimbursement – Yes, YouReimbursement – Yes, You
Can Have All ThreeCan Have All Three
Miriam Lieber
and
Colette Weil

2. (c) Lieber/Weil2010
SeminarObjectivesSeminarObjectives
 Examine opportunities in operations and
marketing to build cash sales
 Discuss cash sales situation with
reimbursables
– Ex. wheelchair, oxygen and bed
 Review how to selectively use ABN
 Explore how to build cash sales mentality into
your operations and marketing efforts

3. (c) Lieber/Weil2010
Current MarketplaceCurrent Marketplace
Operations
 Audit frenzy
 Compliance focus
 Competitive bidding
uncertainty
 Convoluted third party
payer contracting
– Smaller coverage
percentages
– More patient out of
pocket
Marketing
 Patient/consumer/
referral source
information paucity
 Clarity in
service/products offered
 Revenue diversification
 Media changes
 Data analysis for
revenue enhancement
 Strength of relationships
 Where to invest

4. (c) Lieber/Weil2010
Patient (Consumer) ExpectationPatient (Consumer) Expectation
 Who defines patient expectation
– Third party payer
– Competitors
– Media
– You
 Patient vs. consumer view
– Patient managed, consumer responsible
 Other healthcare providers approach
– Cash up front
– Participating provider
– Service primarily
– Do not sell other items outside of service necessarily
(soft sell)

5. (c) Lieber/Weil2010
Getting fromPatient toGetting fromPatient to
ConsumerConsumer
 What do other healthcare services do?
– Ask for the money upfront
– Contact info, email info, complete post card for
notification of service or event
 Approach as consumer and from
your consumer’s viewpoint
– Choice
– Referral driven or recommendation
– Services provided
– Education on what is paid for
– What other consumers purchase with primary item
• Why, how, when
– Selection, price, service mix

6. (c) Lieber/Weil2010
Referral ExpectationReferral Expectation
 Satisfy patient
 No complaint calls to office
 Unaware of products/services to help patient
– Time/care/interest?
 Little time to spend on your issues
– Just wants patient taken care of
 Doesn’t want to be second guessed
 Doesn’t want to owe you anything!

7. (c) Lieber/Weil2010
Educating Referral in ConsumerEducating Referral in Consumer
ChangesChanges
 Presentation is key!
– New products, new hope – cash expected
 Explain changing regulations
 Fewer dollars available from third party payers
 Increase in consumer’s financial responsibility
– Equates to increase in consumer’s desire for
knowledge
 Redirect consumer into understanding their
needs can be met if they are willing to pay
– Asking for the money up front is an absolute
necessity!

8. (c) Lieber/Weil2010
Up Front Insurance Gathering =Up Front Insurance Gathering =
Educated IntakeEducated Intake
 Must verify insurance up front
 Solidify payment arrangements before
rendering service
– Even if patient has to wait
 Make educated decision about what to provide
patient
 Obtain medical necessity documentation at
intake
– Ensure payment
– Time to retrain staff and referral community
• After all, other health care providers simply expect
the cash!

9. (c) Lieber/Weil2010
Asking forthe Money Is NotAsking forthe Money Is Not
TabooTaboo
 What’s good for the doctors is good for HME
 Expect cash
 Employ professional, matter-of-fact style
 Once you know how much to expect, you
know how much to collect up front
 If patient doesn’t pay, why render additional
supplies?
– Must check outstanding balance when patient
calls for supply refill
 If you don’t ask, you definitely won’t get!
– Human nature

10. (c) Lieber/Weil2010
Legal Guidelines: Marketing to
Beneficiaries (“Benes”) – What You Can
Do
 May contact by telephone and email if
one of the following exists:
– Beneficiary has given written
permission
– Supplier previously provided covered
item to beneficiary and supplier is
contacting regarding covered item
– Supplier has furnished one covered
item in past 15 months

11. (c) Lieber/Weil2010
Current Customers are Best
Source forMore Business
 Current referral sources change jobs and will
continue to refer
 Current customers refer – after 10 purchases, that
customer has referred 7 customers to you
 Regular customers are worth five to six times
more than anyone else
 Increasing a customer retention rate by only 5%
can boost the average customer net present value
by an astonishing 35% to 95% (Source: Bain & Company: Microsoft Business for Small
and Mid-Size Companies)

12. (c) Lieber/Weil2010

13. (c) Lieber/Weil2010
CustomerService Easy Follow-CustomerService Easy Follow-
UpUp
 Gathering email at intake is critical
 Follow-up timing
 Personal letter, phone call, versus email
– Age dependent
 Complete post card for next notification
 Make sure you know where to find
customer/caregiver
– Next of kin – cell phone, email, text
 Reiterate promise/plan
– Follow-through is key!

14. (c) Lieber/Weil2010
How to Ask/Presentation is KeyHow to Ask/Presentation is Key
 CSR
– Start with one primary Medicare item
– Phone script
• See Tammy Zelenko’s Seminar (Increasing
Cash Flow through Cash Sales)
• Prepared follow-up method
–Letter/email/postcard
 Retail sales person
– Merchandise for easy demonstration
– Show items for need
• Testimonials
 Set incentive
– Monitor for one month - Track sales

15. (c) Lieber/Weil2010
Cash Sales and ReimbursablesCash Sales and Reimbursables
 Hospital Beds
– Sheets
– Pillow
– Sheet lifter
– Egg Crate Cushion
– Bed tray/caddy
– Over the bed table
– Urinal
– Reacher
– Briefs
 Consumer approaches
– Checklist (BB&B)
– Testimonials and
examples
– Stories
– Visuals
– Staff picks

16. (c) Lieber/Weil2010

17. (c) Lieber/Weil2010
Cash Sales and ReimbursablesCash Sales and Reimbursables
 Wheelchair
– Gel or Foam cushion
– Tray
– Underneath Pack
– Transfer board
– Ramp
– Bath items

18. (c) Lieber/Weil2010
Cash Sales and ReimbursablesCash Sales and Reimbursables
 Oxygen
– Over the bed table
– Footrest
– Bed pillows
– Pedlar

19. (c) Lieber/Weil2010

20. (c) Lieber/Weil2010

21. (c) Lieber/Weil2010
General Cash and reimbursableGeneral Cash and reimbursable
itemsitems
 Walker
– Pouch/utility
– Specialized tips
– Basket/pouch
– Tray
 Commode
 Shower chair
– Floor mat
– Hand held shower
– Grab bar
– Back scrubber

22. (c) Lieber/Weil2010
Diabetic Supply Add-on SalesDiabetic Supply Add-on Sales
Item HCPCS Care Reimb. Cost Care Allow. MSRP
Home blood glucose monitor E0607 Y 70.16*
Test strips (50/box) A4253 Y 38.79* 33.43* KL
Lancets (100 ct) A4259 Y 12.66*
Heel/elbow protector N
Pedlar Exerciser N
Sugar free candy - assorted fruits N
Diabetic Lotion - 6 oz. N
Diabetic sock overcalf (size S,M,L) N
*Ceiling allowable

23. (c) Lieber/Weil2010
Medicare Compliant Consumer
 It’s OK to have Medicare consumer buy non-
covered product
 If patient wants a Medicare covered item but
does not want Medicare billed, use ABN and
option 2
 Some are willing to pay after they are
informed of Medicare guidelines
– Transport chair example

24. (c) Lieber/Weil2010
How to Selectively Use ABNHow to Selectively Use ABN
 Patient choice
 Your protection
 Do not coerce
 Explain carefully
 No “blanket” or “generic” ABN but specific use
with legitimate payment doubt is acceptable
 Form is often completed incorrectly
– Use valid reason – script ok – preprinted
reason ok
– Audit for validity

25. (c) Lieber/Weil2010
Existing Patient ValueExisting Patient Value
 Patient’s primary reimbursables
 New emphasis on total patient with consumer
needs over time/life
 Additional patient/family purchases
– Tracking cash purchases by customer #
– Sample of 10 patients, no CSR
• 10 patients with CSR contact
 Frequency of contact
 Average length of relationship
 Impact on cost analysis of grandfathering

26. (c) Lieber/Weil2010
Marketing forMaximumReturnMarketing forMaximumReturn
 Demographics and media matter
 Promotional incentive guidelines for
prospective and current Medicare patients,
$10 retail per item, $50 retail max per year
 Sales on cash items, bundling, free with
purchase
 Manufacturer donated items
 Valuable content to help in decision-making

27. (c) Lieber/Weil2010
What’s YourPlan?What’s YourPlan?
 Primary items/needs to tackle
 Assess target customers in database
 Determine what is the best method of contact for
your audience
 Lay out script
 Materials to be used
 Practice
 Incentive
 Test
 Measure
 Let it roll and count cash

28. (c) Lieber/Weil2010
SpeakerInformationSpeakerInformation
Miriam Lieber
President: Lieber Consulting
15030 Ventura Boulevard, #786
Sherman Oaks, California 91403
818-789-0670
818-990-9466 (fax)
Email: Miriam@Lieberconsulting.com
Website: Lieberconsulting.com
Facebook: miriamlieberconsulting

29. (c) Lieber/Weil2010
SpeakerInformationSpeakerInformation
Colette Weil
Managing Director: Summit Marketing
3 Marsh Drive, Mill Valley, CA 94941
415-388-5303
415-388-2675 (fax)
Email: cweil@summitmktg.com
Website: summitmktg.com