I was raised by a mother who modeled the importance of spending your time investing in others and serving the community at large. In 2002 I was fortunate enough to have the opportunity to partner with my mother and start a company that does both.

Active American Mobility and Medical began in a 600-sq. ft. office space with little inventory, no staff and a lot of hope. We believed that if we treated our customers like family and serviced our referral sources in the manner they deserved, success would eventually come. We were right.

What started as a two-person operation whose product line only consisted of consumer power mobility products is now a multi-location corporation with over 30 employees and a diversified product line, including complex rehab equipment, oxygen and respiratory equipment, home modifications and DME of all types.

While 2002 doesn’t seem that long ago, much has happened since the inception of our small company, and today’s challenges are much different than those of nearly a decade ago. Competitive bidding, audits of all types and benefit policy changes are just a few of the trials that we are currently enduring.

Do We Ever Meet Medicare’s Burden of Proof?

Active American’s initial business model centered around consumer power mobility products, and most of our early Medicare challenges had to do with the Certificate of Medical Necessity (CMN). I remember trying to explain to physicians and their staff s that though it’s called a “Certificate of Medical Necessity,” it doesn’t necessarily “certify” that the equipment is “medically necessary” and that justification must be present in the medical record. We inevitably were asked, “Then why is it called a Certificate of Medical Necessity?”

This is still a great question.

The consumer power mobility benefit has gone through what seems to have been a barrage of attempts to limit its access — none of which have made it easier for beneficiaries or providers.

Removing the first-month purchase option and replacing the CMN with the “face-to-face” requirement are a few of the most notable changes to the power mobility arena. The face-to-face policy has left providers questioning its ambiguity and wondering if we ever meet the burden of proof. It doesn’t help our anxieties when the audit denial percentages say we rarely do. Consequently, consumer mobility products is currently less than 10 percent of Active American’s annual revenue.

Competitive bidding and the ever-increasing bombardment of post- and pre-payment audits have made Medicare less attractive as a payor. In a strategic effort to limit our risk, Active American has gone from being a 100-percent Medicare provider in 2002 to only 37 percent of our 2010 revenue.

Technology Is Better Than Ever

On a positive note, technology has changed the industry in many progressive ways.

The quality of equipment available is better than it’s ever been, and new, innovative products are consistently being designed and manufactured. This is most notably present in the complex rehab industry. Life-changing technologies like “sit-to-stand” standers and digital molding systems have made it possible for the neediest beneficiaries to have access to revolutionary products. Power mobility drive controls and true-tracking drive systems have increased the caliber of Group 3 power products and the components available to operate them.

New billing platforms allow even the smallest providers to efficiently bill themselves and forego outsourcing. Many have built-in controls to track inventory, rentals and DSO. Valuable financial and operational data is readily available to owners and managers at a click of the mouse.

Electronic verification, telephone appeals and the Interactive Voice Response system are great examples of the Centers for Medicare& Medicaid Services (CMS) taking part in the technology movement. Remember those pesky three-way calls? I certainly don’t miss those!

Overall, it has been a great pleasure to be a part of what I consider a one-of-a-kind-industry. I consider it a great accomplishment to have been a medical equipment provider for the past 10 years and would be honored to be in this industry for another decade. Few occupations give the opportunity to improve the quality of life of its clients like the HME industry. Though times are tougher than they’ve ever been, Active American is still able to provide equipment at the level of service my mother taught me people deserve. My hope is that the future still affords us this opportunity.