Re: A little Christmas guilt
Jeff Erenstone
Description
Collection
Title:
Re: A little Christmas guilt
Creator:
Jeff Erenstone
Date:
1/6/2014
Text:
Hello John and other List Serve Members,
You where asking for an example of a letter to send to congress. Below I
made a template to cut and paste.
You can get your Representative information at...
<URL Redacted>
or
<URL Redacted>
-Jeff
Representative XXXXXX
Topic: Illegal actions by CMS regarding Prosthetic and Orthotic regulation.
Dear XXXXXXX:
I am writing to request that you pressure the Center for Medicare and
Medicaid Services (CMS) to follow the Social Security Act and ...
- promulgate Prosthetist and Orthotist status as a Medical Practitioner
and Professional which is separate from the status of a Suppliers
- accept Prosthetist and Orthotist records as part of the medical
records as a medical professional as specified in the Program Integrity
Manual 5.7
- and limit the fraud and abuse in the Orthotic and Prosthetic field by
promulgating the appropriate payment requirements for Orthotic and
Prosthetic care.
CMS has not been following the laws and policies regarding the situations
above as required to by law in 2002. The HHS Office of Inspector General
has recently issued a report to this effect which I reference below.
CMS's improper action has been detrimental to the general Orthotic and
Prosthetic field and my practice directly. We regularly provides care to
Medicare and Medicaid patients. I invite you or a member of your office to
contact me about this the situation. As well, I welcome you to tour my
practice for a better understanding of the care I provide.
Best Regards
XXXXXX
References:
*Social Security Act: Sec. 1834. [42 U.S.C. 1395m] (a) Payment for Durable
Medical Equipment.—* <URL Redacted>
“(F) Special payment rules for certain prosthetics and custom–fabricated
orthotics.—
(i) In general.—No payment shall be made under this subsection for an item
of custom– fabricated orthotics described in clause (ii) or for an item of
prosthetics unless such item is—
(I) furnished by a qualified practitioner; and
(II) fabricated by a qualified practitioner or a qualified supplier at a
facility that meets such criteria as the Secretary determines appropriate.”
*Program Integrity Manual 5.7 - 5.9*
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pim83c05.pdf
The patient’s medical record is not limited to the physician’s office
records. It may include hospital, nursing home, or HHA records and records
from other health care professionals
*10-10-2012 CMS Has Not Promulgated Regulations To Establish Payment
Requirements for Prosthetics and Custom-Fabricated Orthotics*
https://oig.hhs.gov/oei/reports/oei-07-10-00410.asp
On Wed, Jan 1, 2014 at 11:09 PM, John Rheinstein < <Email Address Redacted> >
wrote:
>
> Thanks Jeff,
> Please send a few example letters for those of us who need a little extra
inspiration.
> John
>
> -----Original Message----- From: Jeff Erenstone
> Sent: Sunday, December 29, 2013 9:03 AM
>
> To: <Email Address Redacted>
> Subject: [OANDP-L] A little Christmas guilt
>
> I hope everyone had a nice holiday and are excited about the new year. I
> hope you got chance to catch up with family and relax a bit...... because
> now I am hoping to lay down some Christmas guilt.
>
> Last week I asked for people forward me the letters that they sent to
their
> members of congress regarding our prosthetic regulation problems. I
> receive only 15. First of all, I would like to thank the people who sent
> me letters....Thank you. You are on my Nice list. The rest of you are
on
> my Naughty list.
>
> If you have contacted congress and missed my post or were too busy before
> the Holidays to respond.... please forward it now (preferably in PDF, but
I
> will take any form). However if you have not sent a letter to your
> Representative than you should. It is easy and it part of your
> responsibility to the field. I constantly hear that our field is too
small
> and we don't have an enough lobbyists to influence congress. Well there
> are thousands of you on this list serve and as far as I know only 15 sent
> letters....what do you expect. Most of those 15 got personalized
responses
> (eventually). If they spend to the time to respond than they are at least
> aware of the problem and may be willing to take some small action when
> asked.
>
> So here is what I suggest. Go to
> http://www.house.gov/representatives/find/ and plug in your zip code or go
> to http://www.senate.gov/general/contact_information/senators_cfm.cfm and
> click on your state. Then write an email and send it. Then copy and
paste
> the email to your other representatives. If will probably take you a half
> hour. When you are done, forward the email to me.
>
> We are fighting for the future of our field. We are fighting for our jobs
> and our patients. If you think I am laying on the guilt now...compare
that
> to the guilt that you will feel when you are unemployed or when your
> patients can't get the care they deserve.
>
> Please write about whatever you want. My favorite topic is asking them to
> support our goal of getting the Lower Limb Prosthetic LCD rewritten to
come
> in line with the superior policy (PIM 5.7) and the laws. The following
> sentence should be removed from the LCD because it is unsubstantiated....
>
> Supplier-produced records, even if signed by the ordering physician, and
> attestation letters (e.g. letters of medical necessity) are deemed not to
> be part of a medical record for Medicare payment purposes.
>
> So put contacting your Representative down as a New Years Resolution and
> stick to it. If you are travelling this Holiday, there is no better time
> to write a letter than on a plane instead watching the bad movie and
> drinking the little bottles on alcohol (on second thought the alcohol
might
> help you strike the right tone.)
>
> Do it now and it will help you have a Happy Holidays in the future.
>
>
> -Jeff
>
> Jeff Erenstone CPO
> Mountain O and P Services
> 7 Old Military Road
> Lake Placid NY 12946
>
> www.mountainoandp.com
>
> Phone (518) 523-2419
> Fax (518) 523-7192
>
>
You where asking for an example of a letter to send to congress. Below I
made a template to cut and paste.
You can get your Representative information at...
<URL Redacted>
or
<URL Redacted>
-Jeff
Representative XXXXXX
Topic: Illegal actions by CMS regarding Prosthetic and Orthotic regulation.
Dear XXXXXXX:
I am writing to request that you pressure the Center for Medicare and
Medicaid Services (CMS) to follow the Social Security Act and ...
- promulgate Prosthetist and Orthotist status as a Medical Practitioner
and Professional which is separate from the status of a Suppliers
- accept Prosthetist and Orthotist records as part of the medical
records as a medical professional as specified in the Program Integrity
Manual 5.7
- and limit the fraud and abuse in the Orthotic and Prosthetic field by
promulgating the appropriate payment requirements for Orthotic and
Prosthetic care.
CMS has not been following the laws and policies regarding the situations
above as required to by law in 2002. The HHS Office of Inspector General
has recently issued a report to this effect which I reference below.
CMS's improper action has been detrimental to the general Orthotic and
Prosthetic field and my practice directly. We regularly provides care to
Medicare and Medicaid patients. I invite you or a member of your office to
contact me about this the situation. As well, I welcome you to tour my
practice for a better understanding of the care I provide.
Best Regards
XXXXXX
References:
*Social Security Act: Sec. 1834. [42 U.S.C. 1395m] (a) Payment for Durable
Medical Equipment.—* <URL Redacted>
“(F) Special payment rules for certain prosthetics and custom–fabricated
orthotics.—
(i) In general.—No payment shall be made under this subsection for an item
of custom– fabricated orthotics described in clause (ii) or for an item of
prosthetics unless such item is—
(I) furnished by a qualified practitioner; and
(II) fabricated by a qualified practitioner or a qualified supplier at a
facility that meets such criteria as the Secretary determines appropriate.”
*Program Integrity Manual 5.7 - 5.9*
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pim83c05.pdf
The patient’s medical record is not limited to the physician’s office
records. It may include hospital, nursing home, or HHA records and records
from other health care professionals
*10-10-2012 CMS Has Not Promulgated Regulations To Establish Payment
Requirements for Prosthetics and Custom-Fabricated Orthotics*
https://oig.hhs.gov/oei/reports/oei-07-10-00410.asp
On Wed, Jan 1, 2014 at 11:09 PM, John Rheinstein < <Email Address Redacted> >
wrote:
>
> Thanks Jeff,
> Please send a few example letters for those of us who need a little extra
inspiration.
> John
>
> -----Original Message----- From: Jeff Erenstone
> Sent: Sunday, December 29, 2013 9:03 AM
>
> To: <Email Address Redacted>
> Subject: [OANDP-L] A little Christmas guilt
>
> I hope everyone had a nice holiday and are excited about the new year. I
> hope you got chance to catch up with family and relax a bit...... because
> now I am hoping to lay down some Christmas guilt.
>
> Last week I asked for people forward me the letters that they sent to
their
> members of congress regarding our prosthetic regulation problems. I
> receive only 15. First of all, I would like to thank the people who sent
> me letters....Thank you. You are on my Nice list. The rest of you are
on
> my Naughty list.
>
> If you have contacted congress and missed my post or were too busy before
> the Holidays to respond.... please forward it now (preferably in PDF, but
I
> will take any form). However if you have not sent a letter to your
> Representative than you should. It is easy and it part of your
> responsibility to the field. I constantly hear that our field is too
small
> and we don't have an enough lobbyists to influence congress. Well there
> are thousands of you on this list serve and as far as I know only 15 sent
> letters....what do you expect. Most of those 15 got personalized
responses
> (eventually). If they spend to the time to respond than they are at least
> aware of the problem and may be willing to take some small action when
> asked.
>
> So here is what I suggest. Go to
> http://www.house.gov/representatives/find/ and plug in your zip code or go
> to http://www.senate.gov/general/contact_information/senators_cfm.cfm and
> click on your state. Then write an email and send it. Then copy and
paste
> the email to your other representatives. If will probably take you a half
> hour. When you are done, forward the email to me.
>
> We are fighting for the future of our field. We are fighting for our jobs
> and our patients. If you think I am laying on the guilt now...compare
that
> to the guilt that you will feel when you are unemployed or when your
> patients can't get the care they deserve.
>
> Please write about whatever you want. My favorite topic is asking them to
> support our goal of getting the Lower Limb Prosthetic LCD rewritten to
come
> in line with the superior policy (PIM 5.7) and the laws. The following
> sentence should be removed from the LCD because it is unsubstantiated....
>
> Supplier-produced records, even if signed by the ordering physician, and
> attestation letters (e.g. letters of medical necessity) are deemed not to
> be part of a medical record for Medicare payment purposes.
>
> So put contacting your Representative down as a New Years Resolution and
> stick to it. If you are travelling this Holiday, there is no better time
> to write a letter than on a plane instead watching the bad movie and
> drinking the little bottles on alcohol (on second thought the alcohol
might
> help you strike the right tone.)
>
> Do it now and it will help you have a Happy Holidays in the future.
>
>
> -Jeff
>
> Jeff Erenstone CPO
> Mountain O and P Services
> 7 Old Military Road
> Lake Placid NY 12946
>
> www.mountainoandp.com
>
> Phone (518) 523-2419
> Fax (518) 523-7192
>
>
Citation
Jeff Erenstone, “Re: A little Christmas guilt,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/235910.
