Re: Who to blame?

Re: Who to blame?

Jim DeWees

3/27/2013

Hello Everyone,

Thanks Jan for posting this!

I want to just follow up with some action going on, related to this audit
issue.

As I reported about 6 months ago, I went to DC and met a couple others from
our profession and my state, and met with our Senator's office, and then I
went to meet with my congressman and his staff. While that seemed to have
no immediate impact on the issues going on at the moment, it did set the
stage for my congressman to be aware of this issue.

I reported last Friday that I did file another formal complaint with the
SBA, and have a case number for this claim. PLEASE take time and do this!!
It takes literally 10 minutes to go online, find the File a Complaint tab,
then fill in the information. This DOES get followed up, and while it won't
provide any instant action or any instant help or relief, it WILL pile up
more and more against CMS and these unethical audits.

BUT, as long as we do NOTHING, and do not even follow up on our appeals, it
does send a loud message to Congress and CMS that they ARE recouping a LOT
of money from this industry. As Sara posted yesterday, they did a net of
over $600 million in overpayment recovery. That is a considerable chunk of
money. And, even if we have a letter signed by some members of Congress
going to the Sec. of HHS urging her to do something to fix this audit
problem, when she can see they are recouping that kind of money every year
from DME and O&P, it would make NO sense for her to stop this process if
they are getting money back into the system that is broken.

We MUST make sure that we are doing EVERYTHING totally compliant, have all
documentation, and make sure our friends and colleagues in this field also
are doing it right! Then we must defend ourselves and show how these audits
are not fair.

Besides just reporting this to the SBA for help, also I feel that reporting
this to the Office of Inspector General (OIG) is another useful tool we
have. They will have to investigate the claim, and find out why someone at
National Gov Services has made a decision to not pay me because the
physician wrote Eager to get prosthetic leg and return to his normal life
(which fully expresses this patient's life and his needs to walk) and that
doesn't say Desire to walk.


BUT the best news is yesterday my congressman's staff member who runs the
district office called me. First off, he said they had the Provider
Relations person from Nat. Gov. Services (an Anthem company here in Indiana)
in their office (in the congressman's district office) and asked him why
there were SO many complaints against them from physicians, therapists and
everyone. I guess my name came up in the meeting they had. So, he called
me yesterday to see what he could specifically do for me. He is aware of
the SBA complaint, and the OIG complaint. I told him about the Freedom on
Information request I also filed. I filled out the Consent Form for him
to now take over this issue for me!! He is going to meet with the NGS
person again this week, and he is going to specifically show him what the
physician's notes state, and what the Appeal process ruling from NGS
decided. He will ask for him to defend his company's decision. He will ask
him (urge him) to reverse this.

I was also asked to be part of a congressional round table with a dozen
medical professionals to help figure out this mess of our healthcare reform
issues, and come up with valid solutions or ideas that could help prevent
more problems. Of course, I accepted that invitation.

Things are moving forward.

On a good note, I am now up to 9 audits. I have been paid on ALL of them
but the first one (the one where the word Eager does not mean Desire).
This helps me in my fight for this ONE claim....it shows that obviously I am
doing this all right, and submitting the information to NGS in the audit
request. Hopefully someday they will realize that I get ALL this
information together BEFORE I deliver any legs. I have been doing this for
over a year now. I have only been getting audits since November. BUT I
have the documentation. It is NOT easy to keep track of. It is SLOWING
down the delivery time of prosthetics in a major way. The worst case it
took me about 8 weeks to get the patient to see his physician (no appts
available for the physician for that long), and to get his notes from the
physician. Then it took me 3 weeks to make the leg (cast, check socket,
lamination, etc.) Typically, it adds about 2 weeks to the process to get
the physician's notes.


Thanks

Jim DeWees

-----Original Message-----
From: Jan
Sent: Wednesday, March 27, 2013 8:24 AM
To: <Email Address Redacted>
Subject: [OANDP-L] Who to blame?

Stop crying about the audits, and do something. Contact your elected
officials, then follow up every 2 weeks to see what is done. Stay
persistent! It is just like a patient with a squeaky foot, they will stay on
you until you fix it. Do the same to your officials. They WILL get tired of
hearing us. SBA only reports 40 (that's all) from our industry. SBA reports
directly to congress.
Get off your butts and make something happen, don't wait for someone else to
do it, it is your future, your money.
Jan Saunders, CPO