Random Probes?
Saunders, Jan CPO
Description
Collection
Title:
Random Probes?
Creator:
Saunders, Jan CPO
Text:
I was wondering if anyone else on the server is experiencing what appears to
be a strong arm tactic by Medicare , and some of the insurance companies to do
Random probes.
Medicare Dmerc Spring 2004 update . states that:
Prosthetic socket replacements on previous wearers
Above the knee\Below the knee
Custom AFO's .
Custom Knee
The information which is being requested in most cases , is information we as
practitioners have no control over. The physician is documenting a custom
knee brace, the doctor had been called to see if an off-the-shelf knee brace
would work and still wants custom and now should Medicare's advisers feel this is
not necessary . we are unable to be reimbursed by the patient or by Medicare
, unless of course , now if we were smart enough to have the patience sign and
ABN up front, in which case having patience sign ABN has a routine practice
is illegal . we have a chance to collect from the patient is the patient has
funds available.
When it comes to previous prosthetic wearers and not only do they require
documentation of physical changes , which is appropriate. But this now will get
thrown into Random probe , which will delay the payments between 90 and 120
days.
Does anyone know if any of our national Association's are having discussions
with CMS . I am sure that this is not a regional problem . since this was
issued in the DMERC.
It is my opinion that this goes back many years ago , when we were classified
as DME vendors and not considered healthcare professionals. So the question
is why do we pay dues, why do we support our national Association's and why
have they had their head in the sand for so long. What the problems which are
facing our industry and have been for quite sometime until the time comes .
when we are respected and considered healthcare professionals rather than DME
salesman . we do not have a chance at continuing to exist as a profession as we
will be swallowed up by other he healthcare professionals .
if you have any feedback . I look foward to hearing some other opinions.
Jan Saunders LPO, CP
be a strong arm tactic by Medicare , and some of the insurance companies to do
Random probes.
Medicare Dmerc Spring 2004 update . states that:
Prosthetic socket replacements on previous wearers
Above the knee\Below the knee
Custom AFO's .
Custom Knee
The information which is being requested in most cases , is information we as
practitioners have no control over. The physician is documenting a custom
knee brace, the doctor had been called to see if an off-the-shelf knee brace
would work and still wants custom and now should Medicare's advisers feel this is
not necessary . we are unable to be reimbursed by the patient or by Medicare
, unless of course , now if we were smart enough to have the patience sign and
ABN up front, in which case having patience sign ABN has a routine practice
is illegal . we have a chance to collect from the patient is the patient has
funds available.
When it comes to previous prosthetic wearers and not only do they require
documentation of physical changes , which is appropriate. But this now will get
thrown into Random probe , which will delay the payments between 90 and 120
days.
Does anyone know if any of our national Association's are having discussions
with CMS . I am sure that this is not a regional problem . since this was
issued in the DMERC.
It is my opinion that this goes back many years ago , when we were classified
as DME vendors and not considered healthcare professionals. So the question
is why do we pay dues, why do we support our national Association's and why
have they had their head in the sand for so long. What the problems which are
facing our industry and have been for quite sometime until the time comes .
when we are respected and considered healthcare professionals rather than DME
salesman . we do not have a chance at continuing to exist as a profession as we
will be swallowed up by other he healthcare professionals .
if you have any feedback . I look foward to hearing some other opinions.
Jan Saunders LPO, CP
Citation
Saunders, Jan CPO, “Random Probes?,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/223114.
