Medicare problems

Medicare problems

Wil

3/20/2013

Hello Colleagues and Guests,

Things have been quiet recently, but work is still being carried on in
behalf of finding solutions for the CMS/Medicare/Medicaid problems. I
have been working on this issue on a fairly regular basis since last
summer and can report that the problems within the L-Code system are
real and, in some cases, quite serious. One case in point is L0631. If
you haven't looked at this code and studied it, relative to others
around it, you are perhaps, like me, asleep at the wheel. Of course
everyone in O&P likely knows about the seriousness of the audits which
are having some devastating consequences on our profession.

As I look back in time, this moment in our time reminds me of the days
when the local drugstores succumbed to the forces from larger chains, or
business investors, if you will. Regardless of your opinions about that,
it changed the face of pharmacy. If we are not careful, the face of O&P
may change soon as well. If that happens, it will likely have some
serious affects on some folks who will least suspect it.

When this is all settled, at the end of the day I believe the auditing
process will have benefits for the O&P profession. With that said, you
must think that I have totally gone off my rocker and you are right, I
have. But in the process of some fairly radical thinking, I have also
learned quite a bit about some of the issues that seem to be driving the
auditing process.

The good news is, I believe these problems are solvable in a manner that
will eventually compliment everyone involved with the problems that we
are now facing. That is not to say some will not take a major hit,
because I believe they will and rightfully so. From the beginning, I
have said that the real power with the auditing issues lie with Medicare
and Medicaid recipients. I still believe that, although it appears that
involvement from these folks will not happen and, I believe that should
have been predicable. As medical services are curtailed, hopefully they
will cry out and make a difference. In the meantime, we need to get our
own house in order and work with CMS officials in an open and honest
manner. Long term solutions will only come when we recognize the
problems and then decide to do something reasonable to help solve them.

For now, the solution for getting paid for your O&P services is to make
sure that every regulatory t is crossed and every i is dotted. It is
very costly and time consuming, but for the moment it is the only answer.

I know that people throughout the U.S. are working in various ways to
help each O&P practice improve their operations and odds of staying
alive. As solutions appear, things should start to get better. I could
go on about what I personally believe needs to be done, but for now,
I'll just say that people are working to help improve the situation.
Hopefully, we will see results from some of this soon.

I will soon start my ride into the O&P sunset, although I'm taking the
back roads as I go, so it will hopefully be slow. But don't worry, I
will continue to irritate as many of you as I can. I'll also still be
working in any way that I can to help the O&P profession and will still
have family members involved in the profession. You will soon see a
couple of surveys from one of our associations or me. With that said, it
will likely encourage them to get rolling since my surveys are much to
folksy and non-scientific. Anyway, some of us are still hard at work
trying to help improve our current situation.

Wil Haines, CPO