- Human Interest
- O&P Practitioner
- Physical Therapist
- Other Healthcare Professional
Posted By: Wil on September 6, 2012
Hello Colleagues and Guests,
/If you don't want to read the entire post, which you should, at least
go to the last paragraph.
This email is a brief summary of our visit with Senator Dan Coat's
office on Wednesday of last week in DC. Chris Haines, my daughter,
Jim DeWees, CP from Bloomington, IN, his son, and I were in attendance
and we met with Samuel Blevins, legislative correspondent. Our focus
was the prepayment regulations that are being enforced by Medicare
and also to point out the discrepancies within the November 2011
Prosthetic OIG report. Fortunately, we were given ample time to
discuss these issues and also to share other opinions about fixing
the Medicare O&P system.
In a nutshell, we stated that:
1. Medicare's prepayment policy is wrong and needs to be addressed
quickly if many O&P practices are to survive the prepayment onslaught.
2. The Prosthetic OIG report is flawed and in many cases without merit.
3. Physician's (very few excepted) know very little about prosthetic
prescription writing and don't want to know.
4. There needs to be separation of O&P from DME. (critically important
to resolve problems regarding O&P services)
5. House and Senate bills, HR 1958 and S 773, currently in progress, or
stalled, are flawed and do not appropriately recognize the professional
6. Medicare can expect federal lawsuits in the near future, based upon
decisions made with erroneous data and inappropriate prepayment policies.
7. And, there were a few other topics discussed relative to the problems
involved with O&P within the Medicare system and also the VA.
Our recommendations/ /included:
1. Predetermination authorizations for O&P services as an immediate fix.
This was discussed at least as a temporary fix for the prepayment audits.
2. Separation of O&P from DME. We briefly discussed the logic of this
separation, along with a brief explanation of how this could save Medicare
a lot of money, but will need to expand upon this in much greater detail
in the near future./We did not discuss the following, but we believe it//
//makes sense.//Congressional leaders have the power to make legislative//
//changes and this is one that needs to be done. Since Medicare seems//
//unwilling to consider this, perhaps an appropriately written piece of//
//legislation is necessary. Part of this legislation would have physicians//
//develop their "L Code" system (perhaps P Codes) and also have therapists
//develop their codes as well (perhaps T Codes). Since they are currently exempt//
//from the regulations and policies that are imposed upon O&P, they should be
able to talk// //the talk and walk the walk. As such, they should also be able
to formulate// //their own billing system for the comprehensive O&P systems that
they are// //supposedly qualified to provide.//Additionally, since they are able//
//to bill for professional service time, in addition to the L-Codes they submit
on claims,//their reimbursement should reflect this as well or we should be
included in their system wherein we would be able to include professional
evaluation and follow-up time, the same as they are.
3. Immediate termination of prepayment audits.
4. Limit CMS/Medicare policy changes to one time per year. Then give us 90
days to comply.
National Government Services (NGS) had responded to an inquiry by Dan
Coat's office and we were given a copy of their reply. This document is
now on the oandpsolutions.org website under documents and NGS. It doesn't
take long to recognize that this document was written with the typical
boilerplate responses in which we are familiar. We will soon reply to
the NGS letter, but would first like to hear your comments. I believe
many will have problems navigating to the website, so here is a method
to get there. Go to the ngsmedicare.com home page on your browser, click
at the top where it says DME (on that line), then go to resources, and
then tools and materials. You will not easily find the documents referenced
in the letter from NGS. As such, type "checklist" in the search box on the
tools and materials page, scroll, and you will eventually find the documents
(likely two or three times) that are referenced. We would like to hear your
comments about these referenced documents as well.
Finally, since I did not readily find any checklist that referenced
prosthetics, I did a search for prosthetics from the tools and materials
page. I think I found more than 600 documents, but of course many of
those are not relevant to our immediate concerns and there are a lot of
duplications as well. What I did find though was a document entitled
"Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
Quality Standards, dated February 2012." This document is now located on
the oandpsolutions.org website in the same areaas above. Please read
section II, and appendix C. You may also be interested in reading the
list of approved accrediting agencies. We would like to hear your
comments about this document. While the NGS letter is specifically for
Region B, we believe this or similar documents may exist for the other
regions as well.
There is so much information in the above reference documents, it's hard
to know where to start, so we'll appreciate your comments as you read
In our opinion, separation of O&P from DME is absolutely essential
(without compromise) to the survival of our profession and is equally
essential to lessening the fraud and abuse that we are wrongfully, for
the most part, being accused of. Anything less will be "business as
usual." I don't know about you, but I've had enough of this "business as
For better or worse, we would like to hear your comments. Then we will ask
you for your time and consideration in helping us formulate a "common sense"
approach for providing Medicare recipients with the O&P services they need.
So that everyone will know, there are no fees involved in this project and
no monies will be accepted by companies, associations, or for ads. This is
strictly a grassroots effort with each of us participating as we are able.
Finally, everyone needs to send letters to their congressional representatives
and also to the SBA complaint division in the Ombudsman area regarding the
prepayment problems, as well as any other problems that you are aware of. If
we fail to act now to get this immediate prepayment problem resolved, we
believe you can expect a lot worse in the near future. We believe this
is a fight we can win and we also believe it should also open up opportunities
for a better dialogue between us and Medicare if we will take the time to get
involved. This is not just an Indiana issue, it is a national issue.
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