- Human Interest
- O&P Practitioner
- Physical Therapist
- Other Healthcare Professional
Medicare Audits/Washington DC visit
Posted By: Jim DeWees on September 6, 2012
I just want to pass along some information about my recent trip to Washington, DC and the conversations and meetings that I had.
I first want to thank Wil Haines and Christine Haines for going through the process of getting an invitation from our Senator Dan Coats (Indiana) to meet with his staff. After I learned about this opportunity to go to DC and meet with this office, I contacted my Congressman's office, Todd Young, and was invited to meet with his staff to also discuss this current issue we are facing in this field.
To summarize what happened with Dan Coats' office, and to add upon what Wil is reporting about this meeting as well, we took a lot of documentation to their office to review. Wil's office spent a lot of time preparing excellent notes for them, and binders with information explaining what was going on.
The staff member, Sam Blevins, was very interested in our conversation, and listened intently on everything we were telling him. We presented him with cases where it appears that medicare has been unfair in their dealings, and also demonstrates a total lack of clarity in what they are sending to the providers for explanations for rejections or seeking more information.
What we ended up suggesting to him is that CMS must make several changes, some of them need to be immediate.
Here are the suggestions, which Sam wrote down, and also underlined them during our conversation:
1. CMS must implement a "Pre-determination" process, which would make the contracted payers review the documentation BEFORE we invested any time, money, or materials for a patient. This will help prevent any of the "fraud" (which we pointed out is more a lack of compliance with the CMS requirements, which are changing on a daily basis...I shared with him that in one year, I have gotten 863 emails from CMS listserve, which is crazy). This will also prevent the need to do these pre-payment audits, since all the paperwork will have already been reviewed BEFORE services are rendered.
We recognize this will slow down the process of patients being fit with prosthetics, but with that in mind, we need to require that CMS put a 48 hour time limit on their review of these pre-determinations. We pointed out that Medicare Advantage Plans (Humana, UHC, and Anthem) already do require pre-authorizations for prosthetics. And, in our region, the carrier is a company that is owned by Anthem, and they are already equipped to do pre-authorizations, pre-determinations, etc.
2. We also recommended that CMS be limited to ONE time per year where they can make changes for policy, billing requirements, etc. He strongly agreed with that, and recognized that getting multiple emails from CMS every day, with hidden policy changes in some of these emails is not practical.
3. We suggested that the L-codes for O&P be restricted so that only professionals in this field are able to bill for these codes.
These are common sense solutions for these problems we are faced with.
When I finished with the Senate office, I took my 10 year old son to lunch in the cafeteria of the Capitol Building. Then we went to the Congressional office building, where we met with the staff member who deals only with medical policies, Emily Mueller. She is a "career staffer" who specializes in medical policies and has several years of experience working with various members of congress over the past several years. She was also very attentive and understood everything I explained to her. She has never really been involved with O&P, but she was shocked at how we invest so much money into componentry and the time invested in making a limb. Then when she realized that Medicare can hold these payments for lengthy periods of time, and quite often are not even paying for them after a long audit process, she was shocked. She agreed that this must STOP. She listened to the same suggestions that we had told the Senator's office. She agreed totally with everything I was explaining to her.
Now, what happens next will be interesting. What I strongly suggest to EACH of you is that you also get involved. You must spend a few minutes, and send emails to your senator's offices, and your congressman's offices. Explain what is going on. Explain that our profession cannot continue to operate under these circumstances.
What I pointed out to these staff members also is I am aware of offices and practitioners that are not providing services to Medicare beneficiaries. This is NOT fair to these seniors that need our services. And, honestly, I feel that is going to be the driving force behind any changes that might occur. IF they can see that seniors are not getting proper, appropriate or acceptable services because of these audits, that is what will drive a change to occur.
I truly enjoyed visiting Washington, DC, and being part of a democratic process and being able to actually meet with our political leaders (or their staff members), and voice my opinions and concerns. It was amazing to be part of this process. I took my 10 year old son with me, and he was also in these meetings, and he enjoyed it as well. He was adopted from China at the age of 5. He remembers his childhood days in China, in the orphanage. He was born missing his right hand, and so I feel that having him with me at these meetings also made these staff members realize even more how important prosthetic limbs are to the amputees. I have a below knee amputation as well, and made sure that I expressed to them that without a prosthetic leg, I am really challenged....just getting around with no prosthetic leg is difficult, either using crutches or a wheelchair. They totally understood that, and could see how that is true. With a prosthetic leg, wearing long pants, they didn't even know I was an amputee until I pointed that out to them. With a prosthetic leg, I can work with no problems, I can run, walk, and do everything. They recognized this, and can see how important prosthetic limbs are.
So, again, it is up to you all to stand up now, and get involved. The more of us that speak up, and have a unified voice on why these audits need to stop, and what we must do to help prevent this "fraud" (which I explained before, making the rules CLEAR for all of us to know what is required), then we will see the higher chances of getting this fixed and the rules changed.
If anyone needs help in finding contact information for your government officials, please feel free to call me, or email me, and I will get these numbers and addresses for you.
Jim DeWees, CP
Prosthetic Center of Indiana
|The message above was posted to OANDP-L, the e-mail discussion list for orthotics and prosthetics.|