Re: Who else are being audited? New ?: Where is CMS on pre-auths
Albert J Garney
Description
Collection
Title:
Re: Who else are being audited? New ?: Where is CMS on pre-auths
Creator:
Albert J Garney
Date:
4/3/2013
Text:
Fellow list serve users:
Original question: Is it only the O&P professionals being audited or are the physicians, physical therapists, companies that have sales people fitting OTS devices also included in these audits? The answer is no, other professionals are being audited.
I did receive many responses with many different “tones” in their answers. Some responses call for that we as a group need to stop crying about audits and do something about the current situation. I agree. Some thought the original question, although simple, needed to be asked. I am enlighten by recent post from fellow list serve users about their positive from their local politicians. On the other hand, a local colleague of mine received a negative letter after filling out the form letter that AOPA auto generated to our local politician this past week. You can contact me directly for a copy of the letter. Of course there will be multiple sides to this and frankly I believe we are just going to have to adjust to our new environment, which is going to unfortunately slow down patient care because we have to triple check that all the “I’s” are dotted and the “T’s” are crossed be scheduling a patient for delivery of the device.
Now don’t get me wrong, I am glad to see CMS auditing and finding fraud and making vendors pay back for abusing the system in whatever form they used. I have seen too many C-Legs propped up in the corner of assistive living facilities. Most of them only being used 1 hour a day during their restorative care treatments.
I would just like to see CMS get to a point that there is a systematic method on how documentation should be compiled, particularly with how the referring physician documents the need for a brace or a prosthetic device. Maybe take a page out of the diabetic shoe process. Although, not perfect, at least the Medicare guidelines allow for the majority of the documentation to generate by the vendor (specialist that is an expert in what is being provided) and they physician documentation is considerably simple. I know CMS has the requirements spelled out about what documentation is needed, but when I see from recent post that a prosthetic device was denied because the doctor did not write in his dictation the patient “desire” to receive a device, or CMS is rejecting evidence base video that a patient can navigate stairs, uneven surfaces as proof of a K level during and audit. Sorry but I’m calling “BS”!!!
The pre-auth would be the best method to reduce risk for both the vendor and CMS. At least we can be told that documentation needs to be better, if that’s the case, up front before any time and money is put out on treating the patient. I am not really seeing this in discussions. Maybe I’m missing it. It would be nice to see the money that is being put out for audits just poured into a pre-authorization panel of some kind. My limited understanding is that CMS is doing some studies in 3 or 4 states with 2 phases. First is the RAC’s then in a about a year or so they will explore the pre-auth approach. I know that CMS has to be methodically in their approach, and we are just along for the roll-a-coaster ride to see how things flush out.
So my new question for the week is, where is CMS on pre-auths?
All the best
Albert J Garney, CPO
Prince William Orthotics and Prosthetics, LLC
8644 Sudley Rd
Suite 305
Manassas, VA 20110
www.pwop.net
Follow on Face Book < <URL Redacted>>
703-368-7967
From: Albert J Garney [mailto:<Email Address Redacted>]
Sent: Friday, March 29, 2013 2:02 PM
To: Albert Garney
Subject: Fwd: Who else are being audited?
Albert Garney,CPO
Prince William Orthotics & Prosthetics
8644 Sudley Rd Suite 305
Manassas VA 20110
< <URL Redacted>> www.pwop.net
Office. 703-368-7967
Cell. 571-247-8641
Begin forwarded message:
From: Albert J Garney < <mailto:<Email Address Redacted>> <Email Address Redacted> >
Date: March 26, 2013, 6:56:16 PM EDT
To: <mailto:<Email Address Redacted>> <Email Address Redacted> < <mailto:<Email Address Redacted>> <Email Address Redacted> >
Subject: Who else are being audited?
Greetings everyone:
I have a quick question. Is it only the O&P professionals being audited or are the physicians, physical therapists, companies that have sales people sitting OTS devices also included in these audits?
Case in point with the recent article in the O&P almanac that showed over 61,000 claims on the L0361 were mostly provided by physical therapist, physicians and other DME providers that were not traditional O&P professionals.
In my opinion this is what got us into the current environment and I hope that they are also being included within the Medicare audits.
Albert Garney,CPO
Prince William Orthotics & Prosthetics
8644 Sudley Rd Suite 305
Manassas VA 20110
< <URL Redacted>> www.pwop.net
Office. 703-368-7967
Cell. 571-247-8641
Original question: Is it only the O&P professionals being audited or are the physicians, physical therapists, companies that have sales people fitting OTS devices also included in these audits? The answer is no, other professionals are being audited.
I did receive many responses with many different “tones” in their answers. Some responses call for that we as a group need to stop crying about audits and do something about the current situation. I agree. Some thought the original question, although simple, needed to be asked. I am enlighten by recent post from fellow list serve users about their positive from their local politicians. On the other hand, a local colleague of mine received a negative letter after filling out the form letter that AOPA auto generated to our local politician this past week. You can contact me directly for a copy of the letter. Of course there will be multiple sides to this and frankly I believe we are just going to have to adjust to our new environment, which is going to unfortunately slow down patient care because we have to triple check that all the “I’s” are dotted and the “T’s” are crossed be scheduling a patient for delivery of the device.
Now don’t get me wrong, I am glad to see CMS auditing and finding fraud and making vendors pay back for abusing the system in whatever form they used. I have seen too many C-Legs propped up in the corner of assistive living facilities. Most of them only being used 1 hour a day during their restorative care treatments.
I would just like to see CMS get to a point that there is a systematic method on how documentation should be compiled, particularly with how the referring physician documents the need for a brace or a prosthetic device. Maybe take a page out of the diabetic shoe process. Although, not perfect, at least the Medicare guidelines allow for the majority of the documentation to generate by the vendor (specialist that is an expert in what is being provided) and they physician documentation is considerably simple. I know CMS has the requirements spelled out about what documentation is needed, but when I see from recent post that a prosthetic device was denied because the doctor did not write in his dictation the patient “desire” to receive a device, or CMS is rejecting evidence base video that a patient can navigate stairs, uneven surfaces as proof of a K level during and audit. Sorry but I’m calling “BS”!!!
The pre-auth would be the best method to reduce risk for both the vendor and CMS. At least we can be told that documentation needs to be better, if that’s the case, up front before any time and money is put out on treating the patient. I am not really seeing this in discussions. Maybe I’m missing it. It would be nice to see the money that is being put out for audits just poured into a pre-authorization panel of some kind. My limited understanding is that CMS is doing some studies in 3 or 4 states with 2 phases. First is the RAC’s then in a about a year or so they will explore the pre-auth approach. I know that CMS has to be methodically in their approach, and we are just along for the roll-a-coaster ride to see how things flush out.
So my new question for the week is, where is CMS on pre-auths?
All the best
Albert J Garney, CPO
Prince William Orthotics and Prosthetics, LLC
8644 Sudley Rd
Suite 305
Manassas, VA 20110
www.pwop.net
Follow on Face Book < <URL Redacted>>
703-368-7967
From: Albert J Garney [mailto:<Email Address Redacted>]
Sent: Friday, March 29, 2013 2:02 PM
To: Albert Garney
Subject: Fwd: Who else are being audited?
Albert Garney,CPO
Prince William Orthotics & Prosthetics
8644 Sudley Rd Suite 305
Manassas VA 20110
< <URL Redacted>> www.pwop.net
Office. 703-368-7967
Cell. 571-247-8641
Begin forwarded message:
From: Albert J Garney < <mailto:<Email Address Redacted>> <Email Address Redacted> >
Date: March 26, 2013, 6:56:16 PM EDT
To: <mailto:<Email Address Redacted>> <Email Address Redacted> < <mailto:<Email Address Redacted>> <Email Address Redacted> >
Subject: Who else are being audited?
Greetings everyone:
I have a quick question. Is it only the O&P professionals being audited or are the physicians, physical therapists, companies that have sales people sitting OTS devices also included in these audits?
Case in point with the recent article in the O&P almanac that showed over 61,000 claims on the L0361 were mostly provided by physical therapist, physicians and other DME providers that were not traditional O&P professionals.
In my opinion this is what got us into the current environment and I hope that they are also being included within the Medicare audits.
Albert Garney,CPO
Prince William Orthotics & Prosthetics
8644 Sudley Rd Suite 305
Manassas VA 20110
< <URL Redacted>> www.pwop.net
Office. 703-368-7967
Cell. 571-247-8641
Citation
Albert J Garney, “Re: Who else are being audited? New ?: Where is CMS on pre-auths,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/235074.
