Cat out of the bag news
Wil Haines
Description
Collection
Title:
Cat out of the bag news
Creator:
Wil Haines
Date:
11/10/2008
Text:
Thanks for all of the replies regarding reimbursement parity for
orthotists and prosthetists. I received a few good and important links,
but nothing pointing to the Federal Register or Code of Federal
Regulations. I believe these documents are important because they
dictate what happens by others, including CMS, at the administrative
level. Hopefully, we can get this sorted out without too much
difficulty. The General Accounting Office has issued at least two
reports that say additional funding for O&P services is not necessary
inasmuch that the reimbursement levels provide enough profit without
adding charges for additional fitting or follow-up services. But the GAO
reports do not mention the fact that the administrative burden for O&P
services has increased significantly since the L-Code system was
implemented. So, in reality, the Medicare rules have changed, but the
reimbursement factors for the rule changes have not. I have seen reports
that suggest that the administrative burden for physicians is now
approximately 35% of their revenue, without regard to O&P services. If
true, I believe this makes a compelling case for O&P to get this matter
adjusted with Medicare. And, since the L-Code system is totally separate
from the CPT coding system, my guess is that this reimbursement parity
issue has been totally overlooked by the federal government.
But before we start firing cannons, I learned something recently that
gives me some hope that a solution to this matter is already being
worked on. I certainly hope this is true. So, until I can get additional
information about this, I am going to put this issue on hold. I will
update the listserve though as soon as possible and I hope it will not
be long before you hear more about this.
Wil Haines, CPO
MaxCare Bionics
Indianapolis, IN
orthotists and prosthetists. I received a few good and important links,
but nothing pointing to the Federal Register or Code of Federal
Regulations. I believe these documents are important because they
dictate what happens by others, including CMS, at the administrative
level. Hopefully, we can get this sorted out without too much
difficulty. The General Accounting Office has issued at least two
reports that say additional funding for O&P services is not necessary
inasmuch that the reimbursement levels provide enough profit without
adding charges for additional fitting or follow-up services. But the GAO
reports do not mention the fact that the administrative burden for O&P
services has increased significantly since the L-Code system was
implemented. So, in reality, the Medicare rules have changed, but the
reimbursement factors for the rule changes have not. I have seen reports
that suggest that the administrative burden for physicians is now
approximately 35% of their revenue, without regard to O&P services. If
true, I believe this makes a compelling case for O&P to get this matter
adjusted with Medicare. And, since the L-Code system is totally separate
from the CPT coding system, my guess is that this reimbursement parity
issue has been totally overlooked by the federal government.
But before we start firing cannons, I learned something recently that
gives me some hope that a solution to this matter is already being
worked on. I certainly hope this is true. So, until I can get additional
information about this, I am going to put this issue on hold. I will
update the listserve though as soon as possible and I hope it will not
be long before you hear more about this.
Wil Haines, CPO
MaxCare Bionics
Indianapolis, IN
Citation
Wil Haines, “Cat out of the bag news,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/229796.
