Fees For Services Rendered

Fees For Services Rendered

Wil

4/19/2012

Hello colleagues and guests,

In my opinion, the only fair way to calculate and answer the question
recently presented by another practitioner regarding administrative and
other costs of doing business in O&P is to use federal government data,
including federal payroll data. CMS, or any other federal agency cannot
argue with the data that is directly provided by them. After all, isn't
all government spending reasonable? By the way, government employees, on
average, earn considerably more than those in the private sector. This
information is public information and I have been saying for years that
we should tackle this issue head-on with CMS or any other federal or
state agency using their data that cannot be denied as reasonable. Not
only is it hypocritical that CMS allows other qualified professionals
the use of professional time codes when working with orthotic and
prosthetic systems, it is more than likely against federal regulations
if you examine the statutes in place for providing O&P care. I could be
wrong about this, but I would suspect that it is still likely the case.
But until we have the courage to convene in numbers before our
congressional representatives and get to the bottom of these atrocities
well.........................., we are who we are. We tend to congregate
in numbers where our forces are divided and our voices are diminished.
To tackle a federal issue in numbers means that enough folks show up
from the same state to get a congressional representative's attention.
When I was in Ohio, we used to do this all the time at the state level,
often much to our satisfaction. Granted, we had good leaders in Ohio who
could talk the talk and walk the walk and this was very important. I
was not one of those gifted arbitrators. But when we arrived in
Columbus, from all parts of the state, and met with representatives of
government agencies, they knew that we meant business. And, I can
truthfully tell you that they were more often than not, willing to help
us resolve issues that were unfair and problematic for everyone.

Unless things have changed somewhere along the way, to my knowledge, it
is illegal for the federal government to let a contract knowing that the
contractor will lose money. All federal government contracts must
provide for a reasonable profit. Is not Medicare and Medicaid a form
of a government contract? When the government starts asking us for
invoice data and then make reimbursement decisions based upon same at
our peril, then I believe it is time for us to start asking them for
theirs. This is especially true inasmuch that the L-Code system was not
designed as a cost-plus based system and CMS knows that. Any
disagreement? Additionally, since Medicare subcontractors (such as
Advantage plans) are essentially government contracting agents, how is
that they can legally undercut the fees which have been established by
the federal government while acting on behalf of the federal government?

If enough O&P business owners in Indiana are willing to travel to
Indianapolis (or Washington DC for that matter) to meet personally with
one of our federal representatives, I am more than willing to help
arrange such a meeting. But before we go, we have to come to agreement
in advance by way of a few inter-Indiana phone calls, on the issues that
we believe are unfairly eroding our profession and our livelihoods. In
Ohio, we used to do this on a regular basis. If groups from each state
would do the same, I believe we could make significant progress toward
getting some of the unfair policies that are affecting us in O&P
straightened out. Where is the fairness in requiring orthotists and
prosthetists to be responsible for the clinical dictation in the
systemic physician's record of our patients? Simply put, is that a
federal statute? If so, show me the statute. If not, who made the
decision to implement this policy, on what date, and by whose authority?

Wil Haines, CPO
MaxCare Bionics
Avon, IN
(317) 272-9993