Same Similar
Jim Del Bianco
Description
Collection
Title:
Same Similar
Creator:
Jim Del Bianco
Date:
10/1/2019
Text:
Does anyone have any ideas on ways our profession/myself/a group of O&P
offices could positively address the same/similar issues currently
experienced with Medicare and LCDs in general on a broader scope?
I have been told by Medicare even if a device is broken inside 5 years and
outside the warranty they will not pay for a new device despite this being
documented in the Pts chart. Things happen and devices don't always last 5
years. In this case a carbon style Toe off broke after 3 years of use and
it seems the Pt will now have to pay.
Here is the language in the LCD.
Replacement of items due to irreparable wear takes into consideration the
Reasonable Useful Lifetime (RUL) of the item. The RUL of DME is determined
through program instructions. In the absence of program instructions,
carriers may determine the RUL, but in no case can it be less than 5 years.
If the item has been in continuous use by the beneficiary on either rental
or purchase basis for its RUL, the beneficiary may elect to obtain a
replacement.
_________________
On a broader scope there must be a better way to interface with Medicare
regarding these LCDs. It so often seems to come down to Medicare's
interpretation of doc notes not meeting needs where our interpretation of
those notes seems sound in terms of the LCD. In addition, doctors are not
thrilled with being asked to document details that are not relevant to
their scope of the practice.
How can we positively communicate with Medicare and find a way to ensure
fraud is not occurring but prevent O&P providers and doctors from dealing
with the current requirements?
LCDs don't work is the bottom line. There needs to be someway to find out
if the criteria has been met in a prompt manner before delivery. Private
companies use authorization.
Any thoughts here? I am not looking to revolt or get mad over it. I just
want to find some way to help in a professional and reasonable way. I don't
want fraud to occur as much as anyone, but when money is taken back for
items for whom Rxs are obtained along with doctor notes and solid
practitioner notes it can be difficult to feel fairly treated.
My phone calls to Medicare result in them reading back to me the LCD.
There must be a better way.
Jim Del Bianco
offices could positively address the same/similar issues currently
experienced with Medicare and LCDs in general on a broader scope?
I have been told by Medicare even if a device is broken inside 5 years and
outside the warranty they will not pay for a new device despite this being
documented in the Pts chart. Things happen and devices don't always last 5
years. In this case a carbon style Toe off broke after 3 years of use and
it seems the Pt will now have to pay.
Here is the language in the LCD.
Replacement of items due to irreparable wear takes into consideration the
Reasonable Useful Lifetime (RUL) of the item. The RUL of DME is determined
through program instructions. In the absence of program instructions,
carriers may determine the RUL, but in no case can it be less than 5 years.
If the item has been in continuous use by the beneficiary on either rental
or purchase basis for its RUL, the beneficiary may elect to obtain a
replacement.
_________________
On a broader scope there must be a better way to interface with Medicare
regarding these LCDs. It so often seems to come down to Medicare's
interpretation of doc notes not meeting needs where our interpretation of
those notes seems sound in terms of the LCD. In addition, doctors are not
thrilled with being asked to document details that are not relevant to
their scope of the practice.
How can we positively communicate with Medicare and find a way to ensure
fraud is not occurring but prevent O&P providers and doctors from dealing
with the current requirements?
LCDs don't work is the bottom line. There needs to be someway to find out
if the criteria has been met in a prompt manner before delivery. Private
companies use authorization.
Any thoughts here? I am not looking to revolt or get mad over it. I just
want to find some way to help in a professional and reasonable way. I don't
want fraud to occur as much as anyone, but when money is taken back for
items for whom Rxs are obtained along with doctor notes and solid
practitioner notes it can be difficult to feel fairly treated.
My phone calls to Medicare result in them reading back to me the LCD.
There must be a better way.
Jim Del Bianco
Citation
Jim Del Bianco, “Same Similar,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 7, 2024, https://library.drfop.org/items/show/209708.
