Beware!
Rick
Description
Collection
Title:
Beware!
Creator:
Rick
Date:
7/25/2019
Text:
Ok list, here's a good one for you & please beware!
Provided a transtibial prosthesis to a Medicare beneficiary. Got paid for all procedure codes for said prosthesis & supplies except for a miscellaneous code (which was explained, Dr documented & medically necessary). Appealed the denial of payment for the miscellaneous code. Received a notice shortly thereafter that the entire device was provided fraudulently & a request for partial refunds for most of the codes, but not full amounts & not all codes(!?). On the phone, no one could figure out what was going on & no one could explain. Finally, someone tells us: That's our policy now; when you appeal a denied code, we want all payments back so we can review the entire claim. Let that sink in.
Not ok, but then why are only partial repayments requested & what do we do now? My office manager was told to repay everything that is requested in writing & to expect more requests.
Seriously!??? Are we now being penalized for appealing their decisions &/or clerical errors????!
This system is becoming more & more broken.
Rick Milen, CPO/LPennsylvania
Provided a transtibial prosthesis to a Medicare beneficiary. Got paid for all procedure codes for said prosthesis & supplies except for a miscellaneous code (which was explained, Dr documented & medically necessary). Appealed the denial of payment for the miscellaneous code. Received a notice shortly thereafter that the entire device was provided fraudulently & a request for partial refunds for most of the codes, but not full amounts & not all codes(!?). On the phone, no one could figure out what was going on & no one could explain. Finally, someone tells us: That's our policy now; when you appeal a denied code, we want all payments back so we can review the entire claim. Let that sink in.
Not ok, but then why are only partial repayments requested & what do we do now? My office manager was told to repay everything that is requested in writing & to expect more requests.
Seriously!??? Are we now being penalized for appealing their decisions &/or clerical errors????!
This system is becoming more & more broken.
Rick Milen, CPO/LPennsylvania
Citation
Rick, “Beware!,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/209530.
