Attn AOPA documentation we cant control
Albert Garney
Description
Collection
Title:
Attn AOPA documentation we cant control
Creator:
Albert Garney
Date:
8/29/2012
Text:
Okay I'm just venting a little bit but I'm sure I am not alone on this.
Reason why we need to verify everything and cannot trust others for the
paperwork that CMS is going to hold us responsible for.
The wife of a diabetic shoe patient of mine called to make an appointment to
get new shoes and inserts. I kindly explained to her that her husband will
need to see his the diabetic doctor and have a clinic note documented that
the patient needs diabetic shoes as well as the need for the therapeutic
shoe letter to be filled out during that visit. After the documents are
complete we can see him for the diabetic shoes. Wife said, I am on it, I
will get him in to see the doctor and get everything that is need for
Medicare.
Today I received a fax with the signed therapeutic shoe letter but no sign
of a clinic note from the doctors visit. I called the doctor's office to
thank them for the fax of the shoe letter and asked if I could get a copy of
the clinic note for when he had his visit to document the need for diabetic
shoes. They explained that the doctor did not see the patient and that the
patient dropped of the shoe letter form and the doctor was happy to fill it
out as he done in the past.
So I am sure there is a million stories like this but this has got to stop
immediately. Frankly none of us have the time to chase other clinic's
paperwork, we have enough out our own.
So I am not trying to call anyone out from ABC, AOPA or anyone of our fine
organizations, but I do not see anything getting solved about the struggles
our practices and keeping us out of the auditing cross hairs of CMS.
Can someone from AOPA give us all an update of where we are with documents
that are out of our control that also delays treatment of patients. I am
also requesting an update not only for shoes, but also all the recent
chatter for prosthetic device.
My thought and opinions and everyone please respond either if you agree or
disagree
Let get the POS out of DME-POS. There is so much talk about how there is
some much fraud with prosthetic and orthotics services in the DME world.
Everyone should take a look at the OIG website. On there is a section of
people and companies that are excluded from the being able to work with
government entities (CMS, VA..any government office)
<URL Redacted> When I look at
these excluded people and companies I did not see any traditional O&P
facilities or ABC/BOC practitioners. What I did see DME companies
committing fraud with prosthetic orthotics services. Which leads me into my
next thought;
Let protect our field by restricting who can bill L-Codes that are specific
to certified O&P personal and facilities.
Here is example, I've come across this issue and I have seen recent post
about joints similar to the ultra-flex knee or ankle joints. We cannot bill
CMS because they have a rental code. Myself and other said we are not
going to get near that with a ten foot pole because we don't deal with
rentals (more of a DME business model) and explain to the patient it will be
self pay due to non cover item. BUT these DME companies that are committing
fraud don't have certified O&P staff and submitting claims for myo-electric
arms for people that are not even amputees.
Another example is when I had a doctor write a prescription for a Custom
Plastic AFO and referred the patient to me and a separate therapy
prescription for gait training to go with the AFO. The patient first went
to the therapist for initial evaluations, then the next day the patient came
to me to be cast for the AFO as prescribed by the doctor. Being the type of
practitioner who like to get addition feedback and treatment opinions, I
called the therapist. Many days went by with no return call from the
therapist and the patient no showed on the delivery appointment. I called
the patient and found out that the therapist fit an off the shelf AFO (from
a company that routinely markets to therapist to help them increase their
revenue) and that is why the patient did not come into my office to pick up
her custom AFO. Needless to say I was stuck holding the time and materials
for the custom afo. I called the doctor to report that I attempted to have
the patient in for her fitting, but the therapist took it upon herself to
fit and off the shelf brace that was not ordered. Obviously the doctor was
very upset with the therapist's actions. I hoped that the therapist was
stuck with the cost of her brace as I was for mine since the doctor was not
going to sign off on a off the shelf AFO treatment plan. Again my point
here is there are non orthotic and prosthetic staff billing orthotic and
prosthetic codes. I don't bill for gait training when I teach the basic of
walking with a orthotic or prosthetic device. Please don't take money from
my profession and bill for AFO's ect..
Does state licensure really protect from fraud and abuse?
This is my last though for this email. I have not studied this, but on the
surface, it appears that most off the fraud happens in state that have
licensure. Many of the laws allow for non O&P staff to bill and fit
orthotic and prosthetic devices. My understanding is these laws are in
place to protect patients. Which I applaud! But are they really protecting
if there are so many loopholes for people to provide orthotic and prosthetic
services. Again, I am a novice on the licensure subject and I would love to
hear other opinions on this. I have heard from people that it makes us look
bad for trying to exclude everyone but us O&P professionals and this would
be seen by law makers as unfair and prejudice. I'm sorry but I find it
offensive when so many other professionals are picking at my line of work
and I think it's time for the O&P community to go from defense to offense to
save our small business.
AHHHH I feel better after this venting of frustrations. Please I would
like to see everyone thoughts and ideas on the issues that are pushing us
into a corner that is going to be difficult to operate a business in.
Best Regards
Albert J Garney, CPO
Prince William Orthotics & Prosthetics, LLC
8644 Sudley Rd
Suite 305
Manassas, VA 20110
703-368-7967
Reason why we need to verify everything and cannot trust others for the
paperwork that CMS is going to hold us responsible for.
The wife of a diabetic shoe patient of mine called to make an appointment to
get new shoes and inserts. I kindly explained to her that her husband will
need to see his the diabetic doctor and have a clinic note documented that
the patient needs diabetic shoes as well as the need for the therapeutic
shoe letter to be filled out during that visit. After the documents are
complete we can see him for the diabetic shoes. Wife said, I am on it, I
will get him in to see the doctor and get everything that is need for
Medicare.
Today I received a fax with the signed therapeutic shoe letter but no sign
of a clinic note from the doctors visit. I called the doctor's office to
thank them for the fax of the shoe letter and asked if I could get a copy of
the clinic note for when he had his visit to document the need for diabetic
shoes. They explained that the doctor did not see the patient and that the
patient dropped of the shoe letter form and the doctor was happy to fill it
out as he done in the past.
So I am sure there is a million stories like this but this has got to stop
immediately. Frankly none of us have the time to chase other clinic's
paperwork, we have enough out our own.
So I am not trying to call anyone out from ABC, AOPA or anyone of our fine
organizations, but I do not see anything getting solved about the struggles
our practices and keeping us out of the auditing cross hairs of CMS.
Can someone from AOPA give us all an update of where we are with documents
that are out of our control that also delays treatment of patients. I am
also requesting an update not only for shoes, but also all the recent
chatter for prosthetic device.
My thought and opinions and everyone please respond either if you agree or
disagree
Let get the POS out of DME-POS. There is so much talk about how there is
some much fraud with prosthetic and orthotics services in the DME world.
Everyone should take a look at the OIG website. On there is a section of
people and companies that are excluded from the being able to work with
government entities (CMS, VA..any government office)
<URL Redacted> When I look at
these excluded people and companies I did not see any traditional O&P
facilities or ABC/BOC practitioners. What I did see DME companies
committing fraud with prosthetic orthotics services. Which leads me into my
next thought;
Let protect our field by restricting who can bill L-Codes that are specific
to certified O&P personal and facilities.
Here is example, I've come across this issue and I have seen recent post
about joints similar to the ultra-flex knee or ankle joints. We cannot bill
CMS because they have a rental code. Myself and other said we are not
going to get near that with a ten foot pole because we don't deal with
rentals (more of a DME business model) and explain to the patient it will be
self pay due to non cover item. BUT these DME companies that are committing
fraud don't have certified O&P staff and submitting claims for myo-electric
arms for people that are not even amputees.
Another example is when I had a doctor write a prescription for a Custom
Plastic AFO and referred the patient to me and a separate therapy
prescription for gait training to go with the AFO. The patient first went
to the therapist for initial evaluations, then the next day the patient came
to me to be cast for the AFO as prescribed by the doctor. Being the type of
practitioner who like to get addition feedback and treatment opinions, I
called the therapist. Many days went by with no return call from the
therapist and the patient no showed on the delivery appointment. I called
the patient and found out that the therapist fit an off the shelf AFO (from
a company that routinely markets to therapist to help them increase their
revenue) and that is why the patient did not come into my office to pick up
her custom AFO. Needless to say I was stuck holding the time and materials
for the custom afo. I called the doctor to report that I attempted to have
the patient in for her fitting, but the therapist took it upon herself to
fit and off the shelf brace that was not ordered. Obviously the doctor was
very upset with the therapist's actions. I hoped that the therapist was
stuck with the cost of her brace as I was for mine since the doctor was not
going to sign off on a off the shelf AFO treatment plan. Again my point
here is there are non orthotic and prosthetic staff billing orthotic and
prosthetic codes. I don't bill for gait training when I teach the basic of
walking with a orthotic or prosthetic device. Please don't take money from
my profession and bill for AFO's ect..
Does state licensure really protect from fraud and abuse?
This is my last though for this email. I have not studied this, but on the
surface, it appears that most off the fraud happens in state that have
licensure. Many of the laws allow for non O&P staff to bill and fit
orthotic and prosthetic devices. My understanding is these laws are in
place to protect patients. Which I applaud! But are they really protecting
if there are so many loopholes for people to provide orthotic and prosthetic
services. Again, I am a novice on the licensure subject and I would love to
hear other opinions on this. I have heard from people that it makes us look
bad for trying to exclude everyone but us O&P professionals and this would
be seen by law makers as unfair and prejudice. I'm sorry but I find it
offensive when so many other professionals are picking at my line of work
and I think it's time for the O&P community to go from defense to offense to
save our small business.
AHHHH I feel better after this venting of frustrations. Please I would
like to see everyone thoughts and ideas on the issues that are pushing us
into a corner that is going to be difficult to operate a business in.
Best Regards
Albert J Garney, CPO
Prince William Orthotics & Prosthetics, LLC
8644 Sudley Rd
Suite 305
Manassas, VA 20110
703-368-7967
Citation
Albert Garney, “Attn AOPA documentation we cant control,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/234205.
