What Areas?
Carey Jinright
Description
Collection
Title:
What Areas?
Creator:
Carey Jinright
Date:
6/4/2013
Text:
I am inquiring to ask what all areas your department can/will assist small businesses in. I am the owner of an Orthotics Company in Montgomery, Al. I have been in business since 2001 and currently employ 9 people. This is a specialized industry and we maintain many credentials, licenses, and certifications. My reason for writing today is that it seems that our industry has come under attack by the very organization that pays us. Though we are accredited as suppliers and are required to stay current with many requirements, we are being treated as criminals. Please allow me to explain.
CMS has always stated as a Medicare Provider I cannot pay a contractor a commission per claim or referral that they bring in to my office. They have stated that this could lead to improper business practices resulting in fraud. CMS on the other hand has hired an independent contractor to audit claims for them and they are paid a percentage of each claim that they deny or audit. This contractor for my jurisdiction is Connolly and Associates. During the past ninety days I have received more than twenty audits on claims dating back as far as three years. Though there is supposed to be a 45 day comment or discussion period between my company and Connolly on any findings that they discover, this has not been upheld. Connolly on many occasions has sent me a letter stating that they have discovered missing information, and before I can send them what they claim was missing the first time, I am receiving a notice of recoupment from CMS. Connolly has sent me
an audit request on spinal braces that were delivered. Their claim or reason for the audit was that the brace was delivered prior to a spinal surgery and the brace should have been invoiced to the hospital not to CMS. After calling the patients many of them have never had spinal surgery at all, so how could there be a violation? Is this not harassment?My third complaint would be against CMS and the interest that they are charging against these audits. Here is some background of the current process: We receive an audit from Connolly stating that they would like documentation sent to them regarding ten claims. These claims are up to three years old. This requires my staff to stop and go pull a chart that is archived and then go through the chart, complete the proper paperwork, and fax the documentation to Connolly. Remember, I only have nine employees. We gather the ten charts, fax the requested information. In two weeks or more we get a denial stating
that something was missing, (this should start the 45 day discussion period) and the following day we receive a notice of recoupment from CMS stating that they will begin to recoup the money from future payment within 45 days. At this point I have to appeal to both entities with the missing paperwork. This all goes on and we receive ten new audits every thirty days. During the appeal process of the claim in which we have three levels of appeals, CMS is docking interest on the claim every thirty days. I have two claims now that have accumulated more than $120.00 per claim in interest just over the past two months. On these claims there is still no reason for them to deny the claim! I am innocent yet I am being treated as guilty. The interest rate is out of control on these claims and this is money that they have not proven that they are owed! Their answer is that we should pay the money back once Connolly finds a problem and then appeal to get our
money back at a later time to avoid interest! I do not know of anyone that is going to pay a penalty that they do not owe and then fight to get their money back later. My last point is this the term fraud and abuse has become a slogan. We need to have Medicare review the OIG compliance standards and realize that fraud consists of an intent to harm or deceive CMS or other entities. The audit reasons that are being pushed for recoupment are consisting of missing dates on a form or the wrong initials after the physician's name, one recoupment is pending due to a date stamp that was incorrectly applied internally by my staff. Though the physician's signature is dated and corresponds with the fax machines stamped date on the form, CMS is considering this date stamp grounds for recoupment. This is not fraud and this is not the type of technicalities that these contractors were hired to find and control! I have not had one recoupment request for lack of
medical necessity, or the fact that the patient was billed or CMS was billed for equipment that was not delivered or received. I have not had one request that was based on providing the improper equipment or upcoding devices. These are examples of fraud, these are the types of problems that are damaging the industry. Internally we have found that these types of findings result from non-licensed, uncertified practitioners that set out with an intent to fraud the Medicare or private system! The attacks and harassing audits are killing small businesses. Is this an area that your department can help in? I have many, many examples of their overreaching, and I am willing to sign my name or give you any information that you may require to look into these claims. If your department cannot help me, and others like me, please tell me who can. Your time and energy is greatly appreciated!
Carey Jinright, LO, ATP, MSM
Cross and three
CMS has always stated as a Medicare Provider I cannot pay a contractor a commission per claim or referral that they bring in to my office. They have stated that this could lead to improper business practices resulting in fraud. CMS on the other hand has hired an independent contractor to audit claims for them and they are paid a percentage of each claim that they deny or audit. This contractor for my jurisdiction is Connolly and Associates. During the past ninety days I have received more than twenty audits on claims dating back as far as three years. Though there is supposed to be a 45 day comment or discussion period between my company and Connolly on any findings that they discover, this has not been upheld. Connolly on many occasions has sent me a letter stating that they have discovered missing information, and before I can send them what they claim was missing the first time, I am receiving a notice of recoupment from CMS. Connolly has sent me
an audit request on spinal braces that were delivered. Their claim or reason for the audit was that the brace was delivered prior to a spinal surgery and the brace should have been invoiced to the hospital not to CMS. After calling the patients many of them have never had spinal surgery at all, so how could there be a violation? Is this not harassment?My third complaint would be against CMS and the interest that they are charging against these audits. Here is some background of the current process: We receive an audit from Connolly stating that they would like documentation sent to them regarding ten claims. These claims are up to three years old. This requires my staff to stop and go pull a chart that is archived and then go through the chart, complete the proper paperwork, and fax the documentation to Connolly. Remember, I only have nine employees. We gather the ten charts, fax the requested information. In two weeks or more we get a denial stating
that something was missing, (this should start the 45 day discussion period) and the following day we receive a notice of recoupment from CMS stating that they will begin to recoup the money from future payment within 45 days. At this point I have to appeal to both entities with the missing paperwork. This all goes on and we receive ten new audits every thirty days. During the appeal process of the claim in which we have three levels of appeals, CMS is docking interest on the claim every thirty days. I have two claims now that have accumulated more than $120.00 per claim in interest just over the past two months. On these claims there is still no reason for them to deny the claim! I am innocent yet I am being treated as guilty. The interest rate is out of control on these claims and this is money that they have not proven that they are owed! Their answer is that we should pay the money back once Connolly finds a problem and then appeal to get our
money back at a later time to avoid interest! I do not know of anyone that is going to pay a penalty that they do not owe and then fight to get their money back later. My last point is this the term fraud and abuse has become a slogan. We need to have Medicare review the OIG compliance standards and realize that fraud consists of an intent to harm or deceive CMS or other entities. The audit reasons that are being pushed for recoupment are consisting of missing dates on a form or the wrong initials after the physician's name, one recoupment is pending due to a date stamp that was incorrectly applied internally by my staff. Though the physician's signature is dated and corresponds with the fax machines stamped date on the form, CMS is considering this date stamp grounds for recoupment. This is not fraud and this is not the type of technicalities that these contractors were hired to find and control! I have not had one recoupment request for lack of
medical necessity, or the fact that the patient was billed or CMS was billed for equipment that was not delivered or received. I have not had one request that was based on providing the improper equipment or upcoding devices. These are examples of fraud, these are the types of problems that are damaging the industry. Internally we have found that these types of findings result from non-licensed, uncertified practitioners that set out with an intent to fraud the Medicare or private system! The attacks and harassing audits are killing small businesses. Is this an area that your department can help in? I have many, many examples of their overreaching, and I am willing to sign my name or give you any information that you may require to look into these claims. If your department cannot help me, and others like me, please tell me who can. Your time and energy is greatly appreciated!
Carey Jinright, LO, ATP, MSM
Cross and three
Citation
Carey Jinright, “What Areas?,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/235304.
