responses to the Nice RAC post
Jim Young Cp Faaop
Description
Collection
Title:
responses to the Nice RAC post
Creator:
Jim Young Cp Faaop
Date:
3/18/2013
Text:
Summarized;
Not funny, but still funny subject line. - I try, often get into trouble
for going for the funny.
How do we get interest? Ask for it in your replies to the audits, it
becomes an issue that the ALJ, or Judge/adjudicator may consider as part of the
ruling. I am not aware of a specific code or statue that specifically
addresses the interest topic. As hard as it may be to determine, I am no lawyer.
I am seriously considering retaining council, or exploring the viability
of a class action case for the harassment the NGO RAC's targeting our small
profession.
copied -
I, too, have a 100% reversal rate at the ALJ level. My office has about 30
separate appeals in process. I do know that Medicare likes to ignore and
overlook interest rates when reimbursing providers after a favorable
decision is issued. You definitely just have to keep on them. They know the rules,
but until a provider reminds them of the rules, they will not follow them.
With regards to your court hearing, I am almost positive you will receive
a favorable decision. As a current law student and provider involved in
many current ALJ hearings, I know that all judges put substance over form.
Meaning, they look at the reasonableness of the situation and look solely to
what will provide a just result. They do consider rules and regulations, but
will overlook them to come to a just and fair decision. So, keep fighting.
Contacting your local congressman and senator is the best thing you can do.
Legislative help is the only thing that will change this madness. I have
been in contact with my local representative, senator and Small Business
Association. Congress, literally, has no clue as to the damage and destruction
being caused by Medicare's audit system. They need to hear from us
providers. I can provide you will one of my letters, if that will be helpful.
I think the future (or, at least, the near future) will consist of many
more prepayment audits. President Obama has just signed a bill in January 2013
that increased Medicare's audit recovery. Meaning, audits will not only
increase but become more aggressive. But, by putting pressure on Congress, it
will help find a better solution. I have introduced a solution for
Congress: Medicare audits should occur as a pre-authorization rather than
prepayment. For example, providers submit the documentation to Medicare before work
and fabrication begins. That way, the providers do not have to encur the
expenses and are not left with thousands of dollars in debt when Medicare
decides to deny the services based on their bogus interpretation of their own
rules. Seems like a win-win to me. But, Medicare won't go for it because
then they will be the bad guy. But, offer that as a solution to your
representative and see how they respond. - I agree with prior authorization
UNLESS it involves going to court and taking months to get there. As a Mom and
Pop, I do not have the resources to have a legal team to argue every case
before a judge.
edited to remove sales aspect - getting your story to your congressman
like you mentioned in your listserv post. We are doing as much as we can to
get the word out to all of the congress people in the united states about
the audits; there NEEDS to be a change. We have 31 states so far and we are
trying to get all 50 by April 1st.
copied - Wow! Just wow! I think the one part you left out is that YOU
spent your
OWN funds on this court appearance while Medicare spent OUR funds. It's not
their money, it's OURS in the form of taxes. And you are right, they likely
spent $5000 to deny a foot costing 1/5 that. So, so sad. Thanks for
fighting for ALL OF US.
Always ask for interest when you first reply to defend your case, and
every time
you correspond. I learned this in the 80's. Back then the gov't paid
better interest then the banks.
In many jurisdictions (for actual court cases, not ALJ) the winning
party is entitled to legal fees. Can amount to thousands. For this
reason always track the time you spend gathering the information,
copies made (charge per page), staff time, consulting with your
attorney, actual legal fees. Base your time rate on what you are
paid.
I will send more if they are much different, Jim.
James O. Young Jr., LP, CP, FAAOP
Amputee Prosthetic Clinic
Macon, Tifton, Albany
888FAKELEG 888fakeleg.com
Not funny, but still funny subject line. - I try, often get into trouble
for going for the funny.
How do we get interest? Ask for it in your replies to the audits, it
becomes an issue that the ALJ, or Judge/adjudicator may consider as part of the
ruling. I am not aware of a specific code or statue that specifically
addresses the interest topic. As hard as it may be to determine, I am no lawyer.
I am seriously considering retaining council, or exploring the viability
of a class action case for the harassment the NGO RAC's targeting our small
profession.
copied -
I, too, have a 100% reversal rate at the ALJ level. My office has about 30
separate appeals in process. I do know that Medicare likes to ignore and
overlook interest rates when reimbursing providers after a favorable
decision is issued. You definitely just have to keep on them. They know the rules,
but until a provider reminds them of the rules, they will not follow them.
With regards to your court hearing, I am almost positive you will receive
a favorable decision. As a current law student and provider involved in
many current ALJ hearings, I know that all judges put substance over form.
Meaning, they look at the reasonableness of the situation and look solely to
what will provide a just result. They do consider rules and regulations, but
will overlook them to come to a just and fair decision. So, keep fighting.
Contacting your local congressman and senator is the best thing you can do.
Legislative help is the only thing that will change this madness. I have
been in contact with my local representative, senator and Small Business
Association. Congress, literally, has no clue as to the damage and destruction
being caused by Medicare's audit system. They need to hear from us
providers. I can provide you will one of my letters, if that will be helpful.
I think the future (or, at least, the near future) will consist of many
more prepayment audits. President Obama has just signed a bill in January 2013
that increased Medicare's audit recovery. Meaning, audits will not only
increase but become more aggressive. But, by putting pressure on Congress, it
will help find a better solution. I have introduced a solution for
Congress: Medicare audits should occur as a pre-authorization rather than
prepayment. For example, providers submit the documentation to Medicare before work
and fabrication begins. That way, the providers do not have to encur the
expenses and are not left with thousands of dollars in debt when Medicare
decides to deny the services based on their bogus interpretation of their own
rules. Seems like a win-win to me. But, Medicare won't go for it because
then they will be the bad guy. But, offer that as a solution to your
representative and see how they respond. - I agree with prior authorization
UNLESS it involves going to court and taking months to get there. As a Mom and
Pop, I do not have the resources to have a legal team to argue every case
before a judge.
edited to remove sales aspect - getting your story to your congressman
like you mentioned in your listserv post. We are doing as much as we can to
get the word out to all of the congress people in the united states about
the audits; there NEEDS to be a change. We have 31 states so far and we are
trying to get all 50 by April 1st.
copied - Wow! Just wow! I think the one part you left out is that YOU
spent your
OWN funds on this court appearance while Medicare spent OUR funds. It's not
their money, it's OURS in the form of taxes. And you are right, they likely
spent $5000 to deny a foot costing 1/5 that. So, so sad. Thanks for
fighting for ALL OF US.
Always ask for interest when you first reply to defend your case, and
every time
you correspond. I learned this in the 80's. Back then the gov't paid
better interest then the banks.
In many jurisdictions (for actual court cases, not ALJ) the winning
party is entitled to legal fees. Can amount to thousands. For this
reason always track the time you spend gathering the information,
copies made (charge per page), staff time, consulting with your
attorney, actual legal fees. Base your time rate on what you are
paid.
I will send more if they are much different, Jim.
James O. Young Jr., LP, CP, FAAOP
Amputee Prosthetic Clinic
Macon, Tifton, Albany
888FAKELEG 888fakeleg.com
Citation
Jim Young Cp Faaop, “responses to the Nice RAC post,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 7, 2024, https://library.drfop.org/items/show/234891.
