OIG Report Regarding Qualified Providers
Wil
Description
Collection
Title:
OIG Report Regarding Qualified Providers
Creator:
Wil
Date:
10/17/2012
Text:
Hello Colleagues and Guests,
I've added a link to the oandpsolutions.org website, compliments of John
Billock, regarding the fact that CMS has not promulgated an important
federal law related to comprehensive O&P services that was passed by
congress over ten years ago. This is a summary of the OIG report
regarding this federal regulation and the full text as given to me a few
days ago by Ryan Ball is also listed at this site and can be downloaded.
This is the kind of information that is very helpful to our cause for
fairness with CMS and is helpful to each O&P professional. Although this
lack of promulgation was pointed out to CMS by our associations in the
past, only now that the OIG has picked up on it, does it seem to become
important to CMS. This clearly illustrates that CMS has failed to some
extent on their part to help curtail fraud and abuse within the O&P
profession, as required by federal law. It further illustrates the
importance for each of us to complain to our legislators about the
unfair and often unnecessary CMS regulations that are being shoved down
the throats of physicians and O&P professionals.
While I am at it, I received copy of upcoming CMS regulations that will
make your heads swim and it appears that they are on the way to being
implemented. The regulations that I perused, will make is very tempting
for physicians to stop writing prosthetic and comprehensive orthotic
prescriptions when that is possible. When unreasonable and time
consuming regulations become the law of the land, I believe physicians
will find ways to lessen their burdens and that will not be good for
those needing prosthetic and orthotic care. Third world prosthetic and
orthotic care in the U.S. for Medicare recipients may be just around the
corner if we don't take the bull by the horns and get some common sense
back into the O&P system.
I have been asked on more than one occasion how you can support our
cause in this Medicare battle for O&P fairness. The short answer is to
write your congressional representatives with first hand illustrations
of cases where deserving citizens are being denied appropriate O&P care.
In other matters, such as prepayment audits, write to them and also to
the Small Business Administration Ombudsman Department, complaining
about the unfairness that CMS is imposing with the prepayment audits and
also the unreasonable regulations regarding the provision of O&P care.
Finally, lets all get on board with a plan that helps CMS, the
physicians, the patients, and ourselves. This can be done with a
coordinated effort starting from the ground up (back at home). My
suggestion is that we insist that O&P professionals be given the
authority to write the definitive CMS compliant prescription, get
agreement for same from the attending physician, and then hold the O&P
professional accountable for the treatment dispensed. We'll need support
from the AMA and, I believe, this is possible given the
non-revenue-producing administrative burden that is being levied against
physicians regarding the provision of comprehensive O&P care. We need to
examine our scope of practice statement and add additional training for
the O&P community to make sure that all O&P practitioners are duly
trained to provide the evaluations that are being required by CMS. We
also need to have CMS curtail unreasonable regulations. A good example
of this can be found in an old report by Mayo Clinic wherein they
recognize that, for the sake of time, it is not practical to have senior
citizens evaluated to the same extent that might be given to a younger
person with the same disability. As such, I believe they came up with a
condensed version of a strength and gait evaluation that appropriately
serves the purposes at hand. It is called the get up and go test and
is a good example of what common sense solutions can provide. If this
test suggests that more testing is required, then fine, we get the
appropriate level of additional testing. We need to petition CMS to
ensure that they use reasonable regulations regarding O&P care and we
need to hold them accountable for their actions, just as they hold us
accountable for our actions. Just because some bureaucrat determines
such and such documentation is necessary to prove medical necessity
for O&P care, doesn't mean they are correct. As we all know, it is one
thing to talk the talk and quite another to walk the walk.
Wil Haines, CPO
MaxCare Bionics
Avon, IN 46123
I've added a link to the oandpsolutions.org website, compliments of John
Billock, regarding the fact that CMS has not promulgated an important
federal law related to comprehensive O&P services that was passed by
congress over ten years ago. This is a summary of the OIG report
regarding this federal regulation and the full text as given to me a few
days ago by Ryan Ball is also listed at this site and can be downloaded.
This is the kind of information that is very helpful to our cause for
fairness with CMS and is helpful to each O&P professional. Although this
lack of promulgation was pointed out to CMS by our associations in the
past, only now that the OIG has picked up on it, does it seem to become
important to CMS. This clearly illustrates that CMS has failed to some
extent on their part to help curtail fraud and abuse within the O&P
profession, as required by federal law. It further illustrates the
importance for each of us to complain to our legislators about the
unfair and often unnecessary CMS regulations that are being shoved down
the throats of physicians and O&P professionals.
While I am at it, I received copy of upcoming CMS regulations that will
make your heads swim and it appears that they are on the way to being
implemented. The regulations that I perused, will make is very tempting
for physicians to stop writing prosthetic and comprehensive orthotic
prescriptions when that is possible. When unreasonable and time
consuming regulations become the law of the land, I believe physicians
will find ways to lessen their burdens and that will not be good for
those needing prosthetic and orthotic care. Third world prosthetic and
orthotic care in the U.S. for Medicare recipients may be just around the
corner if we don't take the bull by the horns and get some common sense
back into the O&P system.
I have been asked on more than one occasion how you can support our
cause in this Medicare battle for O&P fairness. The short answer is to
write your congressional representatives with first hand illustrations
of cases where deserving citizens are being denied appropriate O&P care.
In other matters, such as prepayment audits, write to them and also to
the Small Business Administration Ombudsman Department, complaining
about the unfairness that CMS is imposing with the prepayment audits and
also the unreasonable regulations regarding the provision of O&P care.
Finally, lets all get on board with a plan that helps CMS, the
physicians, the patients, and ourselves. This can be done with a
coordinated effort starting from the ground up (back at home). My
suggestion is that we insist that O&P professionals be given the
authority to write the definitive CMS compliant prescription, get
agreement for same from the attending physician, and then hold the O&P
professional accountable for the treatment dispensed. We'll need support
from the AMA and, I believe, this is possible given the
non-revenue-producing administrative burden that is being levied against
physicians regarding the provision of comprehensive O&P care. We need to
examine our scope of practice statement and add additional training for
the O&P community to make sure that all O&P practitioners are duly
trained to provide the evaluations that are being required by CMS. We
also need to have CMS curtail unreasonable regulations. A good example
of this can be found in an old report by Mayo Clinic wherein they
recognize that, for the sake of time, it is not practical to have senior
citizens evaluated to the same extent that might be given to a younger
person with the same disability. As such, I believe they came up with a
condensed version of a strength and gait evaluation that appropriately
serves the purposes at hand. It is called the get up and go test and
is a good example of what common sense solutions can provide. If this
test suggests that more testing is required, then fine, we get the
appropriate level of additional testing. We need to petition CMS to
ensure that they use reasonable regulations regarding O&P care and we
need to hold them accountable for their actions, just as they hold us
accountable for our actions. Just because some bureaucrat determines
such and such documentation is necessary to prove medical necessity
for O&P care, doesn't mean they are correct. As we all know, it is one
thing to talk the talk and quite another to walk the walk.
Wil Haines, CPO
MaxCare Bionics
Avon, IN 46123
Citation
Wil, “OIG Report Regarding Qualified Providers,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/234049.
