oandp.com

Dear Colleagues and Guests,

For those of you who might be interested, a comprehensive project is now
under way regarding the pre-payment auditing problem, as well as other
O&P related Medicare issues. To be quite honest with you, from what I
see on the listserve, there does not seem to be much "fire-in-the-belly"
regarding these problems at the present time. I suspect that will change
soon. At any rate, I hear a lot of complaining, but I see or hear little
that is being done to address these important Medicare issues. I
understand the "if it ain't broke don't fix it" logic, but friends, in
case you haven't figured it out yet, our system is crumbling in front of
our eyes. If that is not broke, I don't know what the definition of
broke might be. Just because Medicare is now focusing on the high-end
and K3 prosthetic claims does not mean that you won't later have to
provide detailed information for even the smallest of claims. A
post-payment audit is just as harmful to you, except that it takes
Medicare a little longer to get their money back. The administrative
cost to you though is the same, either way.

We recently started a website (oandpsolutions.org) that has the
potential to help all of us if we'll take the time to be involved. When
Medicare or other agencies related to O&P cause problems because of
unreasonable policy decisions and/or regulations, we need to get
together collectively and hold those people responsible for their
actions. As I've said many times before, I believe this is best
accomplished from the outside in, rather than the inside out. In other
words, we need to have clients/patients/customers involved at the local
levels and we also need to have our local O&P professionals involved at
the local level as well. The problems do not exist in Washington, DC.
They exist here in Avon, Indiana and everywhere else around the country
where folks are affected by unreasonable policies and procedures.

The website will not help us solve anything right now, other than
provide a few links for important contacts. But as data from O&P
professionals, legislatures, and other agency officials is posted, it
will soon become evident who the responsible parties are for making some
of these nonsensical rules. At that point, we can really start to make
things happen. There is one document at the website that I believe folks
need to read. It is the OIG report about fraud and abuse in the O&P
community. I won't go into any details about the errors that I believe
are there, but I'd sure like to hear your thoughts about the report.

What we need right now is a written reply with your recommendations for
helping Medicare correct and find meaningful solutions for the rampant
fraud and abuse that is going on. Using the bell curve, of course, we'll
select the best and throw the rest. Your replies can be anonymous and
that is okay. If you prefer, names and addresses can be attached. They
can be long or short; it doesn't matter. But they do need to be
thoughtful and, hopefully, logical.

We will soon be making a case for separation of O&P from DME. I know
many people will say that is futile and the time and energy associated
with it will be ill-spent. So be it. The process needs to start
somewhere and it might as well be with me since I'm dumb enough to open
the can of worms. At a minimum, it will allow me to expose some very
real injustices that are associated with the DMEPOS system. If you would
like to throw your thoughts this way regarding separation of O&P from
DME, I'd sure like to hear them. In essence, there seems to be two
healthcare professional standards within the Medicare O&P field. One for
us and one for the rest of "them."

We need your replies within the next 10 days if you want your thoughts
included in this endeavor. Our primary focus will be to get relief from
DMERC pre-payment audits that are presently causing a lot of financial
strain for a lot of folks. In many cases, it comes down to K level
information that is lacking somewhere in the records. But to deny an
entire claim when everything else would be approved irrespective of
functional levels does not seem right. One of our recommendations at
this time is to have providers sign an affidavit swearing that the claim
is valid and that missing information can be provided in a reasonable
amount of time, subject to penalties and fines otherwise. In the
meantime, pay the claim, so we can stay in business. Does that sound
like a reasonable approach?

Thanks and we hope that we hear from many of you real soon.

Wil Haines, CPO
MaxCare Bionics
Avon, IN