oandp.com

-------Original Message-------

From: [E-mail Address Removed]
Date: 4/23/2015 11:35:29 AM
To: [E-mail Address Removed]
Subject: Fw: Billing before final - responses.

Sorry one that I missed.

Anyone who is caught billing Medicare PRIOR to the delivery of the
Prosthetic device, is really risking their business doing it that way.

In a way, I would LOVE to do that, so that IF Medicare denies the claim and
Doesn't pay for it, then you don't finish it, buy the permanent components,
Etc.

But what Medicare requires today is to have the Manufacturers model number
For the knee and/or foot, with the serial numbers, and everything. BUT
This only applies to anyone who GETS AUDITED!

From the email last week, I was SHOCKED that MOST of the responses about
C-legs and audits, and how MOST said they were NOT getting any audits,
Pre-payment of RAC audits. I was SHOCKED!!!!!!

Here in Indiana, we are STILL getting hammered with audits. I have passed
100% of them, and STILL get audits. There are for EVERY leg, K-1 to K-3
Levels. And to hear about people doiong C-legs and NOT getting audits on
Those??? Really???? Wow.

Anyone that is billing for work that has NOT been completed is in really bad
Danger if they get audited and find that they don't have serial numbers, or
Model numbers, or proof of purchase of the items that are being billed for.

I totally understand WHY they are auditing people, I KNOW many facilities
That are billing BEFORE doing the work, and that is not legal.

If you KNOW of a specific case of this, report it to medicare fraud line,
And turn this in. Anyone doing this SHOULD be reported.





-------Original Message-------

From: [E-mail Address Removed]
Date: 4/23/2015 10:50:43 AM
To: [E-mail Address Removed]
Subject: Fw: Billing before final - responses.

I believe these may be the last of the responses. I think there are clinics
out there that are interpreting the very long standing rule incorrectly, my
advise is to get with your
Jurisdiction representative on the phone and get clarity.

_____________________________________________________________________________
_____
Michelle,

I agree with your final assessment and it is very well written. As someone
who sees a great deal of finished bills and then see the patient with the
prosthesis that should match and I see them for other than Prosthetic
Treatment, I have found a large number of fraudulent billings. The most
frequent one I have found are the cosmetic cover and skin. Some billings
have been for two test sockets, when the client has told me that there was
only one and there is only one in the patient file. If there is a second
test socket, it should have justification in the patient file, but this has
never been found by me.
I say all of this only to protect our Profession from being caught in a lie
and bringing down the 85% that do all of this honestly and properly. I have
found this in even the larger companies that have internal check systems
that are supposed to catch these mistakes.
_____________________________________________________________________________
_________________________________________________________________________

Your understanding is correct.
The work around that I've seen in the Portland, OR area is facilities
delivering what I would consider to be a check socket. They are not making a
laminated socket. The patient is provided a plastic socket and that is the
final delivery. I have even seen facilities that make a plastic socket, use
it as the check socket, and if fit is good then wrap that check socket in
fiberglass tape and tell the patient it is the final product. As long as
they don't bill for carbon fiber and acrylic resin it seems to be a loophole
that some companies are willing to exploit.
_____________________________________________________________________________
___________________________________________________________________________

If the pt leaves your facility with prosthetic components in varying states
of completion, then you should have them sign a delivery ticket. If they
never return you will have standing to take whatever action required, such
as billing, prosecution for grand theft, or whatever. You can only control
what you can control, CYA!
To avoid be accused of unbundling one should not bill haphazardly, and be
accurate and true to the products and professional services rendered, and
ask yourself is it justifiable and supported in the medical record.



Thank you for the insight...




Michele Hattingh
Administrator
Prosthetic Care Facility of VA
15738 Foleys Way
Haymarket VA 20169
571-445-3390
571-4453392
www.prostheticcarefacility.com
Treat others as you want to be treated.