Alternative Senator Congressman Letter 4th Attempt
Lou Haberman CPO
Description
Collection
Title:
Alternative Senator Congressman Letter 4th Attempt
Creator:
Lou Haberman CPO
Date:
8/9/2013
Text:
Dear Senator ______:
I write to express my serious concern with CMS’s systematic persecution of
legitimate Medicare providers, like myself, through overly aggressive
Recovery Audit Contractors (RACs) and other Medicare contractor audits. These
financially incentivized Medicare contractors are destroying the network of
providers across the country that provides prosthetic limbs and orthopedic
braces to Medicare beneficiaries with amputations and other physical
injuries and disabilities.
I have personal experience with these audits and the devastating impact
they are having on my ability to keep my staff employed, provide effective
patient care, and maintain sufficient cash flow to keep my doors open. I am
not exaggerating. Although the RAC audits have accelerated in the past two
years, this situation has grown direr over the past several months. As a
result, many Prosthetic and Orthotic practitioners no longer accept
Medicare patients, or have even been forced to close their doors. More
bankruptcies are imminent. This will further limit patient access for this highly
specialized care.
No one argues that CMS should pursue fraudulent and abusive Medicare
suppliers and providers and root them out of the system. But CMS has gone too
far by failing to control their Medicare Administrative Contractors. These
contractors, including Recovery Audit Contractors (RACs), routinely reopen
large numbers of claims and deny coverage based on technicalities with
little or no recognition that the practitioner provided quality patient care
and the Medicare patient benefitted from the prosthesis or orthosis. These
Medicare claims are routinely overturned in favor of providers, but only
after a lengthy and costly appeals process that diverts attention away from
our patient care responsibilities.
Our national organizations have tried to address this situation over the
past two years at all levels within CMS but without any relief. So I write
directly to you in hopes that you not only become aware of this situation,
but that you consider helping in any way you can.
CMS needs to exercise far greater supervision over its contractors to
ensure that they treat legitimate providers fairly, and Congress should
seriously consider removing the bounty hunter payment that RACs receive for
denying claims. In addition, Congress should adopt additional reforms to the
Medicare program that reduce the amount of claims that can be reviewed, limit
the amount of time it takes to appeal denied claims, and allow providers to
keep Medicare payments until the final appeals decision is made by
Administrative Law Judges (ALJs).
Medicare providers, especially prosthetic and orthotic practitioners, need
your help. I very much appreciate your willingness, and recognition of
the urgency, in addressing these serious concerns.
Sincerely,
I write to express my serious concern with CMS’s systematic persecution of
legitimate Medicare providers, like myself, through overly aggressive
Recovery Audit Contractors (RACs) and other Medicare contractor audits. These
financially incentivized Medicare contractors are destroying the network of
providers across the country that provides prosthetic limbs and orthopedic
braces to Medicare beneficiaries with amputations and other physical
injuries and disabilities.
I have personal experience with these audits and the devastating impact
they are having on my ability to keep my staff employed, provide effective
patient care, and maintain sufficient cash flow to keep my doors open. I am
not exaggerating. Although the RAC audits have accelerated in the past two
years, this situation has grown direr over the past several months. As a
result, many Prosthetic and Orthotic practitioners no longer accept
Medicare patients, or have even been forced to close their doors. More
bankruptcies are imminent. This will further limit patient access for this highly
specialized care.
No one argues that CMS should pursue fraudulent and abusive Medicare
suppliers and providers and root them out of the system. But CMS has gone too
far by failing to control their Medicare Administrative Contractors. These
contractors, including Recovery Audit Contractors (RACs), routinely reopen
large numbers of claims and deny coverage based on technicalities with
little or no recognition that the practitioner provided quality patient care
and the Medicare patient benefitted from the prosthesis or orthosis. These
Medicare claims are routinely overturned in favor of providers, but only
after a lengthy and costly appeals process that diverts attention away from
our patient care responsibilities.
Our national organizations have tried to address this situation over the
past two years at all levels within CMS but without any relief. So I write
directly to you in hopes that you not only become aware of this situation,
but that you consider helping in any way you can.
CMS needs to exercise far greater supervision over its contractors to
ensure that they treat legitimate providers fairly, and Congress should
seriously consider removing the bounty hunter payment that RACs receive for
denying claims. In addition, Congress should adopt additional reforms to the
Medicare program that reduce the amount of claims that can be reviewed, limit
the amount of time it takes to appeal denied claims, and allow providers to
keep Medicare payments until the final appeals decision is made by
Administrative Law Judges (ALJs).
Medicare providers, especially prosthetic and orthotic practitioners, need
your help. I very much appreciate your willingness, and recognition of
the urgency, in addressing these serious concerns.
Sincerely,
Citation
Lou Haberman CPO, “Alternative Senator Congressman Letter 4th Attempt,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/235457.
