O2 and LABA chart notes

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Anonymous

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Lincare rep here- a few questions.. Apria and Rotech reps..are u having to get chart notes from physicians to get paid for Medicare Oxygen referels? Even after the Cmn is back and our company is billing for the 02 we are still not being paid. There is a process in place to print our own chart notes for the dr to sign but its still difficult to get the signature sometimes. Our CSR's should be getting them with sats and dx but they arent and really havent been trained to. Just curious to know what your process was and if it was any different. Same with LABA neb meds and budesonide. Wont even ship without proper chart notes. everything just seems extremely difficult and frustrating.

Ps-definately not a company cheerleader..im pretty miserable but my numbers are pretty good
10-15 02s a month, same with meds, around 5 inr setups, 10 pap

small midwest center

45-50k...

Any comments and/or suggestions appreciated

HME/DME-Where misery loves company!
 


The chart note process is a joke.

Regardless of if your orders come with notes or not it depends on how the order is processed on whether you'll have to submit the notes post fact.

Its all in the batching process.

And.... even though RBCO received it does not meam the correct department receives them...such as the auditing team. Who I firmly believe is a group of third graders fed candy as payment rather than money. Then they're given three stamps: Approved, rejected, and the I have to go number two stamp.

With no specific guidlines or training they then pick any stamp at will and decide if you will be paid or not.

So there you have it. I've had identical notes from the same hopital accepted on one patient then rejected on a different one.

This is not going away. You know how I know? We have over $8000 in chart notes not received pending in our AS400. Do the math on nearly 2000 locations. This is working VERY well for management. V.E.R.Y.
 


Our center in AR had over 100 Medicare O2's not paid out. When we discovered we could use center generated chart notes, we quickly got about 70 of those paid out. After that, we were able to get paid out on our Medicare O2's fairly easily. Well, they are now claiming that we can no longer use the center generated chart notes to get paid. Seriously? So... The new Medicare O2's are being accepted as valid for setup and being billed to medicare if the correct script and saturation levels are documented. However, this is somehow not enough for lincare to pay their sales reps? How is this double standard allowed and if they are billing and being payed by Medicare, why and how are they not paying their reps the commission they have rightfully earned? It seems like they realized reps were again getting paid with center generated chart notes, so, time to put an end to that. Also, Medicare's website clearly states they absolutely do not need these detailed "extra" chart notes. This is a Lincare-generated issue. Good way to offset a loss of 43% revenue-cut in some areas. Well, let's just not pay the reps right? Great philosophy. Sad thing is most of our area reps enjoy their job, are very loyal and work hard for the company. I'm afraid they are not going to keep some of the most loyal reps they have.
"Never push a loyal person to the point where they no longer care".
 


I am in the same boat here. Adding up names through as400 Ihave about 7k worth of commission I am owed. Just learned about the center notes not being valid last Friday. I don't know what they want us to do. Without being paid for medicare 02 I don't know of a single person who would stay. Our base is bottom of the barrel as is. I'm the last or next to last rep left from my training class. Curious to know of any other reps and how they are going about getting paid? Thanks for the replies. Keep them coming!!
 


And this is why I say its not going away. Its effectively a pay cut without saying so.

Thankfully the management in my region has not enforced several non competes. And those employees are still working in the region. Gives the zero ground to stand on if/when I leave.
 


To get paid:

1 pull the chart note from the chart (if you even have enough staff to actually chart). Otherwise find the order in whatever stack it is sitting in.

2 go to CISI and look up the patient. Enter a note in the com log that begins with: "chart note"...then continue to explain why those notes work. You MUST make it so simple a 1st grader can understand it. Not kidding.

3 In the same patients account. Go to selective printing. Look for chart note cover letter. Or something like that.

4 after you print that letter. Fax it along with the notes to YOUR cdr fax. From there it will take about two days to show up accepted or rejected.

5 Keep an eye on the rejected ones. Remember that 1st grader comment? Go back and circle areas of the notes that will make them pass audit.

6 if its rejected after 1st grader proofing it. Youre SOL even though Lincare is gettting paid.

7 if a chart note is rejected prior to you getting the CMN back. Refuse to help getting it signed.

That is all.
 






Anonymous said:
in reference to #6 above...Lincare IS getting paid and then NOT paying their Sales Reps? Really? Why would any employee put up with such foolishness?
Click to expand...

#6 is 100% true. Yes Lincare is getting paid on orders even if chartnotes are not receives by the audit team.

However....lincares opinion is that if we "sales reps" do not get audit proof notes with our orders they will not pay us commission.

However.... the process of sending notes to RBCO, to the audoi team, and from the center is broken. Massively broken.

As stated from myself and the other rep a few posts up there is 15k in unpaid commission from 2 centers alone. Mind you my orders, 99% of them, come with legitimate usable notes. Yet they still end up on the list due to the broken communication between the center, regional billing, and audit 1st graders. And theres a chronic understaffing issue in some regions due to hoq mgt bonuses are calculated. Any bone head can pull out a net profit if you cut enough equipment and staff. It has to change.

Why do I put up with it? I'm not. I used to be a cheerleader for this company. Now I'm just waiting for one of the two companies that can legitimately survive this competitive bidding mess to have a position open.
 


We have a call end of the week on this. Curious to see how it goes. This sounds like half of my week will be spent trying to get notes faxed to the right place. There has to be an easier way then this. The thing that I dont get is that we receive about 4-5 emails a month on patients who medicare is actually auditing, sometimes less. We then go get the notes needed and they are faxed. Why is this not good enough? Is Medicare auditing all patients? I dont see how they could employ enough people to do that? Anyway...sounds like it might be time to get out or move somewhere where I actually get paid for the business I generate. Frustrating!!
 


The auditing is due to wording in Obamacare that allowed 3rd party scum to ambulance chase on medicares behalf. Went into effect in 2009.

Your conference call will go like this:

There is no problem
The process works great (because AMs and regionals lie)


Reality is neither the CSRs nor the reps have the time to monitor it.

Its nearly a full time job at a center as large as mine.
 



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