CMS/ Medicare Survey

CMS/ Medicare Survey

cfairman

2/2/2007

Dear List

It took about 20 minutes, but I just participated in a survey about
Medicare contractors, representatives, the appeals process, audits, etc.

I expressed several times that I felt the representatives had little
knowledge about prosthetics and orthotics when it comes to the
appeals and audit processes.
I also expressed that our field is very incorrectly categorized under
DME. We are not leg and brace stores, but practitioners who provide
very unique and custom services. Sometimes those services are very
difficult to describe and the representatives in turn deny our claims.

An example I gave was how difficult it is to replace and repair a
portion of a broken prosthesis.
I told the survey person the following story: My attempt to save
medicare and our health care system some money turned very difficult.
A very active (part-time police officer, hunter, fisherman, handyman)
patient of mine had broken his multiaxial foot that was nearly 5
years old. His socket, shuttle lock and etc. were in good working
condition. My attempt to bill for a foot and a couple units of labor
for repair turned into a 8 month process that is still unresolved.
We billed for something around $1700. I told the representative that
I've been asked to submit pictures, invoices, write letters, gather
physician documentation, etc. etc. for this repair and it's been
denied several times.

I told the rep, I could have easily obtained a new rx for a complete
new prosthesis and charged medicare between $7k and $10k. I would
have had to make no phone calls, write no letters, copy no invoices,
etc. etc. My attempt to save medicare some money has cost me hours
of wasted time. I know there are practitioners out there who would
make a new prosthesis because it is easier and more profitable. I
told her the difficultly of the system really encourages us to do it
the easy way. The system does not reward us at all for attempting to
save them money. My attempt at an ethical and logical solution will
make me think twice next time.

Another part of the survey dealt with the educational opportunities
the medicare contractors provide us for help in billing, appeals,
audits, etc.
My responses here were based on my own attendance at some local
meetings. 99% of the meeting dealt with wheelchair rentals, and
oxygen supplies. The educators were very well versed in equipment
rental, but had extreme difficulty answering any O and P questions.
(they even wondered why we were in attendance) Again, DME is very
different from O and P.

I would encourage any of you who may get these survey calls to
reiterate these points.

1) DME is not a good category to lump O and P services (we are
educated practitioners, not a leg store).
2) Medicare representatives need more education on the services we
provide.
3) Electronic billing is far from perfect, although getting better
4) The audit and appeals processors need to be better educated on the
services we provide. (999 codes are worthless)

Thanks all.


Chris Fairman CPO
Great Lakes P&O
3075 Clark Rd.
Suite 100
Ypsilanti, MI 48108
734-528-5200

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