Getting to the bottom of our problems
Wil Haines
Description
Collection
Title:
Getting to the bottom of our problems
Creator:
Wil Haines
Date:
11/18/2010
Text:
Dear Colleagues and Guests,
I recently posted a note in response to the notice about pharmacy
accreditation exemptions for O&P. Although, as usual, I received a
couple of less than favorable opinions about my views, I received more
that were in agreement with my views about our O&P dilemma. In
particular, I received one reply that included a well written letter to
a high level program integrity administrator at the Centers for Medicare
and Medicaid Services (CMS) in Washington, DC. To be very honest, that
one letter gives me some hope that, perhaps, we might be able to help
change the failed policies of the Medicare system. I wish that letter
would get posted to a common website where we could all see it.
So now I'll write about some of my personal past experiences with
government issues with hope that a group of O&P practitioners, with a
like-minded agenda, might want to get together and formulate an audit
trail of our own regarding the health and welfare of orthotics and
prosthetics as it relates to Medicare and other third party agencies. I
believe all of these efforts can largely be achieved electronically as a
group. What will be important is that our facts are true and that our
suggestions for change are worthy of helping make things better for
ourselves, our client's (patients), and our government agencies. It will
also require us to be persistent and to not take no for an answer when
things are obviously wrong for our profession. Like many of you, I don't
have the time to tackle these issues alone, but I believe with a central
database of facts and information, along with a plan and plan
administrator, we can collectively be successful. I also believe we may
want an electronic website that can show the rest of the world just what
others in our profession are doing to help bring about change. We may
also want to post the replies that we receive.
Years ago, I was faced with reimbursing Medicare for multiple services
that were declared non-covered after-the-fact. As I recall, it came to
about $10,000.00. I personally went to the Social Security
Administration in Baltimore with a legitimate case file, properly signed
and released by one of the client's where I practiced at that time. The
case file was for an African-American 49 year old female who was
afflicted with cerebral palsy. This person, provided the needed
equipment was supplied, was fully independent and was able to live
without daily assistance. Without the needed equipment, she would
require assistance. I met with about six persons around a large round
table and the group included two or three attorneys who worked for
Medicare at that time. At the end of the meeting, they politely told me
that they sympathized with me and agreed that the case warranted
services, but the law was the law. End of song. So I said to them that
there were obviously willing to spend $50,000.00 to save $5,000.00,
because the law would require this person to be institutionalized
without the needed equipment. As you might guess, that hit a raw nerve
in Baltimore. Needless to say, I was angered by their interpretation of
the Medicare regulations. One the way out of the room, one person
quietly tapped me on the shoulder and asked if I could stay a couple of
minutes longer. Reluctantly, I agreed. He said, Mr. Haines, I cannot
promise you anything, but here is where I think you will find your
answers. At that point, he proceeded to hand me a list of documents
that I would need to purchase at the government printing office in D.C.
Those documents came to about $89.00. Still mad, I took them back home
and gave them to my longtime friend and accountant after relaying the
conversation I had with the gentleman in Baltimore. A few months later,
we had reimbursed Medicare the $10,000.00 they demanded. We also
collected $13,000.00 legally from Medicaid for all of the cases that
Medicare had denied. I'll also add that I stopped at our national office
on my way and before I arrived in Baltimore, someone from that office
phoned ahead to tell the folks at Medicare that I was really a nice
person and harmless.
On another occasion, Medicaid released a statement that they were not
going to pay any claims that were more than one year old. This was
during the time when they were switching to computers. They had a real
mess on their hands. That meant that our company would be out nearly
$42,000.00 back in the late 70's. My accountant, who handled our
accounts receivable at the time, and I made a trip to Columbus, Ohio to
complain about this policy. During that meeting on the 32nd floor of a
government office, in a room with real tableware china and walnut
surroundings, we met with the Director of Medicaid. He had several
assistants with him and they proceeded to show us what was in review,
what was at the treasurer's office for payment, etc., etc., etc. It took
them all of about three minutes and it was all down on 14 green-bar
computer paper. That was my first experience with computers, I think.
The Director asked me what the problem was. With a lump in my throat, I
said I thought it looked okay. Frankly, it was intimidating. They then
asked my accountant if he had any problems. He said he only had one
problem and I could see the look of relief on their faces. But when he
said it doesn't match mine all hell broke loose. That five minute
meeting turned into a two hour meeting, there were a lot of red faces in
the room, and they actually tried to hire my accountant that day in
front of me. Sound preposterous? It's true. The next day, I hand
delivered original invoices for the $42,000.00 worth of claims, sat in a
5' x 5' room (my punishment in a closet) while they made photostatic
copies and we later collected nearly all that amount.
On another occasion, I received a letter of apology from the Ohio
Governor after we were accused of several complaints by BVR clients.
Little did I know at the time that a government summer clerk was a
college student and worked for one of our competitors during the school
year. You might guess how those complaints originated. Fortunately for
us, every person who was named as a complainer by BVR staff stood up in
our behalf and the truth finally came out regarding the problem.
I tell you all of this to say that not once did we hire a lobbyist to
help solve our problems. We solved problems by going head-to-head with
those responsible for their decisions, including congress persons and
other representatives. One of my favorite phrases would later be If it
is a law, please site the reference for us. If it is an administrative
decision, please tell us who made the decision, on what date, and by
whose authority. I learned this from a wise old ex-government
accountant. You may be surprised at the results from such a simple
written phrase. You may also be surprised to find out that some of the
decisions regarding our livelihood are made by folks who really don't
have the authority to make their decisions. I know that many believe our
state and national associations are better suited to help solve these
problems in our behalf. But I believe we need more. We need individuals
who don't have to answer to the association folks. That does not mean
that we would not work together when possible, but it does mean that we
may be going after these problems in a different manner. We also need a
good administrator to help lead the charge.
It is obvious to me that our O&P profession is at risk, largely because
of unfair decisions that are and have been often made by government
regulators. And, our problems seem to be growing exponentially by the
year. As such, I think it is time that some of us who are interested get
together and work out a plan of action to get our profession back. It
will take a lot of work and a lot of personal time. But if we monitor
our letters and responses carefully, keep our duck's in a row, and march
individually and at the same time together collectively with a plan, I
believe we may be able to turn this ship around.
I am hopeful that one person whom I know to be an excellent
administrator might be available and willing to help lead this charge.
I'm halfway decent in the huddle, but we'll need a good leader to help
keep us focused and moving forward. Any volunteers? I will be the first
in line. Thanks.
Wil Haines, CPO
MaxCare Bionics
Avon, IN
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
I recently posted a note in response to the notice about pharmacy
accreditation exemptions for O&P. Although, as usual, I received a
couple of less than favorable opinions about my views, I received more
that were in agreement with my views about our O&P dilemma. In
particular, I received one reply that included a well written letter to
a high level program integrity administrator at the Centers for Medicare
and Medicaid Services (CMS) in Washington, DC. To be very honest, that
one letter gives me some hope that, perhaps, we might be able to help
change the failed policies of the Medicare system. I wish that letter
would get posted to a common website where we could all see it.
So now I'll write about some of my personal past experiences with
government issues with hope that a group of O&P practitioners, with a
like-minded agenda, might want to get together and formulate an audit
trail of our own regarding the health and welfare of orthotics and
prosthetics as it relates to Medicare and other third party agencies. I
believe all of these efforts can largely be achieved electronically as a
group. What will be important is that our facts are true and that our
suggestions for change are worthy of helping make things better for
ourselves, our client's (patients), and our government agencies. It will
also require us to be persistent and to not take no for an answer when
things are obviously wrong for our profession. Like many of you, I don't
have the time to tackle these issues alone, but I believe with a central
database of facts and information, along with a plan and plan
administrator, we can collectively be successful. I also believe we may
want an electronic website that can show the rest of the world just what
others in our profession are doing to help bring about change. We may
also want to post the replies that we receive.
Years ago, I was faced with reimbursing Medicare for multiple services
that were declared non-covered after-the-fact. As I recall, it came to
about $10,000.00. I personally went to the Social Security
Administration in Baltimore with a legitimate case file, properly signed
and released by one of the client's where I practiced at that time. The
case file was for an African-American 49 year old female who was
afflicted with cerebral palsy. This person, provided the needed
equipment was supplied, was fully independent and was able to live
without daily assistance. Without the needed equipment, she would
require assistance. I met with about six persons around a large round
table and the group included two or three attorneys who worked for
Medicare at that time. At the end of the meeting, they politely told me
that they sympathized with me and agreed that the case warranted
services, but the law was the law. End of song. So I said to them that
there were obviously willing to spend $50,000.00 to save $5,000.00,
because the law would require this person to be institutionalized
without the needed equipment. As you might guess, that hit a raw nerve
in Baltimore. Needless to say, I was angered by their interpretation of
the Medicare regulations. One the way out of the room, one person
quietly tapped me on the shoulder and asked if I could stay a couple of
minutes longer. Reluctantly, I agreed. He said, Mr. Haines, I cannot
promise you anything, but here is where I think you will find your
answers. At that point, he proceeded to hand me a list of documents
that I would need to purchase at the government printing office in D.C.
Those documents came to about $89.00. Still mad, I took them back home
and gave them to my longtime friend and accountant after relaying the
conversation I had with the gentleman in Baltimore. A few months later,
we had reimbursed Medicare the $10,000.00 they demanded. We also
collected $13,000.00 legally from Medicaid for all of the cases that
Medicare had denied. I'll also add that I stopped at our national office
on my way and before I arrived in Baltimore, someone from that office
phoned ahead to tell the folks at Medicare that I was really a nice
person and harmless.
On another occasion, Medicaid released a statement that they were not
going to pay any claims that were more than one year old. This was
during the time when they were switching to computers. They had a real
mess on their hands. That meant that our company would be out nearly
$42,000.00 back in the late 70's. My accountant, who handled our
accounts receivable at the time, and I made a trip to Columbus, Ohio to
complain about this policy. During that meeting on the 32nd floor of a
government office, in a room with real tableware china and walnut
surroundings, we met with the Director of Medicaid. He had several
assistants with him and they proceeded to show us what was in review,
what was at the treasurer's office for payment, etc., etc., etc. It took
them all of about three minutes and it was all down on 14 green-bar
computer paper. That was my first experience with computers, I think.
The Director asked me what the problem was. With a lump in my throat, I
said I thought it looked okay. Frankly, it was intimidating. They then
asked my accountant if he had any problems. He said he only had one
problem and I could see the look of relief on their faces. But when he
said it doesn't match mine all hell broke loose. That five minute
meeting turned into a two hour meeting, there were a lot of red faces in
the room, and they actually tried to hire my accountant that day in
front of me. Sound preposterous? It's true. The next day, I hand
delivered original invoices for the $42,000.00 worth of claims, sat in a
5' x 5' room (my punishment in a closet) while they made photostatic
copies and we later collected nearly all that amount.
On another occasion, I received a letter of apology from the Ohio
Governor after we were accused of several complaints by BVR clients.
Little did I know at the time that a government summer clerk was a
college student and worked for one of our competitors during the school
year. You might guess how those complaints originated. Fortunately for
us, every person who was named as a complainer by BVR staff stood up in
our behalf and the truth finally came out regarding the problem.
I tell you all of this to say that not once did we hire a lobbyist to
help solve our problems. We solved problems by going head-to-head with
those responsible for their decisions, including congress persons and
other representatives. One of my favorite phrases would later be If it
is a law, please site the reference for us. If it is an administrative
decision, please tell us who made the decision, on what date, and by
whose authority. I learned this from a wise old ex-government
accountant. You may be surprised at the results from such a simple
written phrase. You may also be surprised to find out that some of the
decisions regarding our livelihood are made by folks who really don't
have the authority to make their decisions. I know that many believe our
state and national associations are better suited to help solve these
problems in our behalf. But I believe we need more. We need individuals
who don't have to answer to the association folks. That does not mean
that we would not work together when possible, but it does mean that we
may be going after these problems in a different manner. We also need a
good administrator to help lead the charge.
It is obvious to me that our O&P profession is at risk, largely because
of unfair decisions that are and have been often made by government
regulators. And, our problems seem to be growing exponentially by the
year. As such, I think it is time that some of us who are interested get
together and work out a plan of action to get our profession back. It
will take a lot of work and a lot of personal time. But if we monitor
our letters and responses carefully, keep our duck's in a row, and march
individually and at the same time together collectively with a plan, I
believe we may be able to turn this ship around.
I am hopeful that one person whom I know to be an excellent
administrator might be available and willing to help lead this charge.
I'm halfway decent in the huddle, but we'll need a good leader to help
keep us focused and moving forward. Any volunteers? I will be the first
in line. Thanks.
Wil Haines, CPO
MaxCare Bionics
Avon, IN
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Citation
Wil Haines, “Getting to the bottom of our problems,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 23, 2024, https://library.drfop.org/items/show/232006.
