Feedback from CGS DME Policy Focused Workshop
RANDY LOYA
Description
Collection
Title:
Feedback from CGS DME Policy Focused Workshop
Creator:
RANDY LOYA
Date:
4/29/2013
Text:
We attended a CGS workshop, “Keys to Medicare Compliance”, in Houston,
Texas, on April 4, 2013 where we were going to discuss coding for Lower
Limb Prosthetics. To say the least, this small round-table type discussion
became heated and tense.**
Before the meeting really even started, we were told First of all,
separate yourself from reality. This is NOT how you start off a meeting.
When discussing K-levels for prosthetics we were told Don't worry about
that word Potential, act like it's not there. If all of the codes are
being driven by K-Levels, created by Medicare, why would Medicare then
decide their wording is inaccurate or vague (like excluding “potential” or
saying that practitioner’s notes are inadequate when the LCD says
otherwise). We were told by Mr. Mark Loney (DMEPDAC) that Medicare will
now consider Microprocessor Knees as a K4 Level component. This directly
contradicts the recommendations of the manufacturers and normal practice
within the industry. In fact, some manufacturers will void their warranty
because of continual K4 activities.
There ARE professionals that provide services for the patient, other than
just for the money (contrary to what Mr. Loney, with DMEMAC thinks). He
asked “What if a patient could get around and function on a lesser valued
K3 knee unit? Wouldn’t that be just as or more appropriate than the
microprocessor knee?” As practitioners, we are trying to help the patient
by providing the best possible care and outcomes rather than just providing
the cheapest thing possible. Healthcare professionals are not taught to
care for their patients by doing the least amount of work. We are taught
to meet our patient’s needs. Medicare is forcing us to focus on the money
more and the patients less. This should not be the ultimate goal for
Healthcare. Medicare seems to be concentrating its effort on providing
care for the patient in the cheapest possible manner when there is a
distinctively better option available for the patient. Patients deserve to
be rehabilitated to the highest level they can achieve.
The phrase Square peg, round hole was reiterated about 10 times when he
did not have a good answer or response to a question. In other words it
doesn't matter what is discussed...it's not going to make sense (or
CENTS)!
Many of us do not mind following rules as long as they do not arbitrarily
change based on reimbursement rather than the efficacy of the services
rendered. Fairness and consistency is all that we ask!
Randy Loya, LAT, COF, COA
Operations Manager/ Practitioner
and
Kirk Hander, CP, LP
Lead Prosthetist
Central Texas Orthotics & Prosthetics, LP
Texas, on April 4, 2013 where we were going to discuss coding for Lower
Limb Prosthetics. To say the least, this small round-table type discussion
became heated and tense.**
Before the meeting really even started, we were told First of all,
separate yourself from reality. This is NOT how you start off a meeting.
When discussing K-levels for prosthetics we were told Don't worry about
that word Potential, act like it's not there. If all of the codes are
being driven by K-Levels, created by Medicare, why would Medicare then
decide their wording is inaccurate or vague (like excluding “potential” or
saying that practitioner’s notes are inadequate when the LCD says
otherwise). We were told by Mr. Mark Loney (DMEPDAC) that Medicare will
now consider Microprocessor Knees as a K4 Level component. This directly
contradicts the recommendations of the manufacturers and normal practice
within the industry. In fact, some manufacturers will void their warranty
because of continual K4 activities.
There ARE professionals that provide services for the patient, other than
just for the money (contrary to what Mr. Loney, with DMEMAC thinks). He
asked “What if a patient could get around and function on a lesser valued
K3 knee unit? Wouldn’t that be just as or more appropriate than the
microprocessor knee?” As practitioners, we are trying to help the patient
by providing the best possible care and outcomes rather than just providing
the cheapest thing possible. Healthcare professionals are not taught to
care for their patients by doing the least amount of work. We are taught
to meet our patient’s needs. Medicare is forcing us to focus on the money
more and the patients less. This should not be the ultimate goal for
Healthcare. Medicare seems to be concentrating its effort on providing
care for the patient in the cheapest possible manner when there is a
distinctively better option available for the patient. Patients deserve to
be rehabilitated to the highest level they can achieve.
The phrase Square peg, round hole was reiterated about 10 times when he
did not have a good answer or response to a question. In other words it
doesn't matter what is discussed...it's not going to make sense (or
CENTS)!
Many of us do not mind following rules as long as they do not arbitrarily
change based on reimbursement rather than the efficacy of the services
rendered. Fairness and consistency is all that we ask!
Randy Loya, LAT, COF, COA
Operations Manager/ Practitioner
and
Kirk Hander, CP, LP
Lead Prosthetist
Central Texas Orthotics & Prosthetics, LP
Citation
RANDY LOYA, “Feedback from CGS DME Policy Focused Workshop,” Digital Resource Foundation for Orthotics and Prosthetics, accessed December 27, 2024, https://library.drfop.org/items/show/234970.
