Interview with Curt Gorman, President, Oticon Medical US
Carolyn Smaka: I’m speaking today with Curt Gorman, Oticon Medical US President, about the news that Oticon Medical has been certified as a Medicare Durable Medical Equipment Supplier. Curt, can you explain what this news means for audiologists, and for their patients?
Curt Gorman: For the past few years, Medicare, or CMS (Centers for Medicare and Medicaid Services), has focused on reducing waste and fraud. As a result, they have stepped up the accreditation process in order to be able to sell durable medical equipment to Medicare patients directly. For instance, there are numerous products that patients can purchase through their Medicare insurance from suppliers. Examples include wheelchairs, canes, and other types of assisted living devices.
Companies need to go through a lengthy and comprehensive accreditation process with Medicare in order to become a supplier. Through the accreditation process, Medicare ensures that the company has the services, billing and processes in place to become a supplier of durable medical equipment directly to Medicare patients. The accreditation process may take a year or more, and also entails two site visits from Medicare. During these site visits, the company’s operations and standard operating procedures are reviewed.
If a company receives accreditation, it is then allowed to sell medical equipment directly to patients, and to bill Medicare directly. For our company, now that we are certified as a Medicare Durable Medical Equipment Supplier, patients who have Medicare can purchase equipment directly from us, and we will bill Medicare. For example, a patient may need a new processor. That patient can purchase the processor through us, we will bill Medicare, and then the patient can take the processor to an audiologist to fit it.
Carolyn: Thanks for that explanation Curt. So the patient’s doctor or audiologist would not be a certified supplier?
Curt: No - most hospitals, doctors’ offices, or health professional would not be durable medical equipment suppliers because Medicare over the years has intentionally moved away from that scenario. In other words, they don’t want hospitals or doctors offices to be the ones selling the durable medical equipment simply because there may be a conflict of interest. In the past, there had been instances of fraud where patients received equipment that they didn’t need, or every patient from a particular practice received some sort of durable medical equipment whether they needed it or not. Now, other than a few exceptions for things like crutches that a patient may need to actually get out the door, most hospitals, clinics, and doctors’ offices are very rarely Medicare durable medical equipment providers.
Carolyn: That makes sense. For patients with an Oticon Medical bone-anchored system, this is mainly going to apply to the speech processor then, not the implant itself?
Curt: Right. Implants and processors for the purpose of surgery for new patients are billed under a whole different system, which the hospital is accredited to do and we are not. This only applies to replacement processors, batteries, and things that the patient may need to purchase after they have already received the surgery and been fit with the device.
Carolyn: Can you get into more details about the process of how this works for the patient? So, for example, if my patient has Medicare and needs a new speech processor for her Ponto, what happens?
Curt: The patient would get a prescription from her doctor as the processor is a prescriptive device. Then the patient would call us, so that we can get some information from the patient to process the order. Once we get the prescription and the paperwork completed, we send the processor to the patient, obtain confirmation from the patient that she indeed received it, and then we bill Medicare. Once the patient receives the processor, they are responsible for getting it programmed from their audiologist, and for any fitting fees for the programming. Typically, patients return to where they were originally implanted. However, there are some clinics across the country that are very large and cater to patients from all over the country. Some patients who were originally fit at these clinics live quite a distance away. In these cases, patients can use the clinic finder on our website to find a location to have the processor fit.
Carolyn: Curt, can you give a few examples of when a patient with a bone-anchored hearing system might need a new processor?
Curt: Approximately 30 percent of people who use bone-anchored hearing systems because of conductive hearing loss; the other 70 percent have single-sided deafness (SSD). We know that as with many patients with hearing loss, with SSD the hearing in the better ear may change over time, i.e., worsen as the patient gets older. When the hearing changes, a more powerful processor may be in order. In addition, technology has advanced very rapidly in this area, and there are new products with new features coming out all the time. Medicare will cover a new processor once every five years or until the processor is no longer useful. So the most common reasons for a new processor are that the patient’s hearing has changed, or that the processor is over five years old and the patient could benefit from new technology that is now available.
Carolyn: Thanks Curt. It all sounds pretty straightforward.
Curt: Yes it is. To summarize, Oticon Medical is now a certified supplier of durable medical equipment with Medicare. Patients who have an Oticon Medical bone anchored hearing system and have Medicare are eligible for a new speech processor every five years, or potentially sooner if their hearing has significantly changed.
Carolyn: We appreciate your time in keeping us updated! Talk to you soon.