Re: zpic denial/dr attestation
Leslie Roberts
Description
Collection
Title:
Re: zpic denial/dr attestation
Creator:
Leslie Roberts
Date:
1/28/2014
Text:
I hate to hear of these stories that sound like complete fabrications of what is going on in the industry right now. But unfortunately I hear them all over the country and know all of this craziness to be sadly true and actually happening. From my perspective, we as an industry will absolutely have to get our patients involved in this fight we are fighting. As much as I agree that taking back a prosthesis or orthosis is unconscionable, it is what we have to do. Please know I do not make this statement lightly or without much thought. We as business owners, practitioners and others that have a financial interest in the O&P business will never be heard or taken seriously. CMS, the auditors and private insurances that are playing these games with our livelihood will never listen to us or take us seriously because we are the ones with a financial interest in what is happening. In their minds, of course we are bawking at what is happening because it is hitting us in the wallet. They do not understand what we do, or even how we do it so having them understand exactly the impact they are having on us and our patients is unrealistic.
What has to happen is our patients are going to have to become vocal about how the government and these ridiculous events are affecting them. They have to tell their stories of how they were not able to get the correct componentry for their ability level because the government is not allowing it. They have to begin fighting for themselves - which in essence is fighting for us as well. They have to speak about how their lives are being negatively affected. That because of the decision to attack the O&P industry, they are not allowed to live the life they could be living. That our government is in effect holding them back. Politicians, lobbyists and the US news media will listen to that. And that, in my opinion, is the only way to chart a new path from the current road we are headed down.
I am not saying the audits that have been happening were not necessary. They have helped us (the practitioners) to become better clinicians/business people and become more aware of our place as one of our patient's medical providers. I fully believe now though, things are being taken too far. And not until our patients start becoming vocal, writing their congressional representatives and demanding to be heard and being their own best advocate will any of this stop. I think the best thing we as O&P industry professionals can do right now is get the word out to our patients and find ways to help them voice their concerns and frustrations to the people that can change things.
Just saying :-)
Leslie Roberts, MSS, CP
> Date: Mon, 27 Jan 2014 18:50:13 -0500
> From: <Email Address Redacted>
> Subject: Re: [OANDP-L] zpic denial/dr attestation
> To: <Email Address Redacted>
>
> I realize Paul's wishes are for list members to respond to sender only. However, I'm just about over all of this M.Care Barbara Streisand.
> That being said, An Academy meeting In Orlando, gave me the opportunity to speak with M.care experts and heads of each of the four regions in seminar setting during the Q&A.
> Question: If I provide an orthosis or prosthesis and the claim is audited and money has been taken by CMS because of poor physician documentation and, an ABN has been signed and refuse to pay the bill for services rendered, can I then repossess said orthosis or prosthesis. I was shocked by their answers. I actually had a little sarcasm in my voice when asking but never thought I would receive the answer I got.
> Answer: Absolutely. This was with no hesitation from each of the four region leaders for DMEPOS.
> I HATE TO SAY THIS. IT MAKES ME SICK EVEN THINKING ABOUT IT. Folks, I'm afraid that what it is going to take for the powers to be,
> To start listening and to stop all this nonsense is to actually repossess a limb or two and watch the sparks fly. I'm sure you will be able to point your disappointed patient in the right direction once you explain why you are taking this unethical drastic measure.
> ENOUGH IS ENOUGH! We can't keep taking it in the shorts with a smile on our face. Drastic action is needed and needed now.
>
> I'm just saying.
>
> Be Well,
>
> Mick Holm, CPO, LPO
>
> > On Jan 25, 2014, at 10:42 AM, Jessica Longoria < <Email Address Redacted> > wrote:
> >
> > We received a claim denial (PRE PAYMENT) from Medicare. We dispensed
> > bilateral prostheses and the ZPIC auditor is stating they are not paying
> > because the physician who signed the detailed prescriptions signed an
> > attestation in 2011 stating she would not prescribe prosthetics. T*his dr
> > is on the pecos list on cms.gov < <URL Redacted>>, she does have an NPI and
> > it also states she is eligible to prescribe DME. *The ZPIC auditor states
> > there is a secret list suppliers *do not and can not *have access to with
> > physicians who have signed this attestation. So in other words, we take a
> > HUGE gamble on providing pricey services and we may not get paid if your
> > referring dr is on this secret list. ZPIC states *this list is separate
> > and diff than the PECOS list*. We can not prevent this claim denial in the
> > future without having access to this info.
> > The zpic auditor emailed this form to the dr's office to complete. The
> > dr's office tell us they immediately completed the form and 100 % sent it
> > to the auditor.
> >
> > Now, the re-consideration has been denied because they are stating the dr
> > did not sign this form (even though the dr corrected it). So now we must
> > go to an ALJ hearing.
> >
> > Has anyone had experience with this type of denial? I would appreciate any
> > input or guidance.
> >
> > Also, we have spoken with the patient. He is willing to return the
> > prostheses, go to a new dr and obtain a new detailed rx and documentation.
> > We will re deliver the legs and then rebill. Has anyone done that?
> >
> > I am currently waiting for over 2 years for an ALJ for another audit and am
> > not willing to wait 2 years on a pre payment audit. I would like to figure
> > a way around this! This is just unreasonable and un-American of our lovely
> > government!
> >
> > Thanks!
> >
> > Jessica longoria, CMF, CP
> >
> > --
> > *Jessica Falknor Longoria*
> > *Centers for Mobility/A Touch of Pink*
> > *7777 Southwest Freeway 107*
> > *Houston, TX 77074*
> > *713-773-0969*
> >
> > *www.CentersForMobility.com < <URL Redacted>>*
> >
> >
What has to happen is our patients are going to have to become vocal about how the government and these ridiculous events are affecting them. They have to tell their stories of how they were not able to get the correct componentry for their ability level because the government is not allowing it. They have to begin fighting for themselves - which in essence is fighting for us as well. They have to speak about how their lives are being negatively affected. That because of the decision to attack the O&P industry, they are not allowed to live the life they could be living. That our government is in effect holding them back. Politicians, lobbyists and the US news media will listen to that. And that, in my opinion, is the only way to chart a new path from the current road we are headed down.
I am not saying the audits that have been happening were not necessary. They have helped us (the practitioners) to become better clinicians/business people and become more aware of our place as one of our patient's medical providers. I fully believe now though, things are being taken too far. And not until our patients start becoming vocal, writing their congressional representatives and demanding to be heard and being their own best advocate will any of this stop. I think the best thing we as O&P industry professionals can do right now is get the word out to our patients and find ways to help them voice their concerns and frustrations to the people that can change things.
Just saying :-)
Leslie Roberts, MSS, CP
> Date: Mon, 27 Jan 2014 18:50:13 -0500
> From: <Email Address Redacted>
> Subject: Re: [OANDP-L] zpic denial/dr attestation
> To: <Email Address Redacted>
>
> I realize Paul's wishes are for list members to respond to sender only. However, I'm just about over all of this M.Care Barbara Streisand.
> That being said, An Academy meeting In Orlando, gave me the opportunity to speak with M.care experts and heads of each of the four regions in seminar setting during the Q&A.
> Question: If I provide an orthosis or prosthesis and the claim is audited and money has been taken by CMS because of poor physician documentation and, an ABN has been signed and refuse to pay the bill for services rendered, can I then repossess said orthosis or prosthesis. I was shocked by their answers. I actually had a little sarcasm in my voice when asking but never thought I would receive the answer I got.
> Answer: Absolutely. This was with no hesitation from each of the four region leaders for DMEPOS.
> I HATE TO SAY THIS. IT MAKES ME SICK EVEN THINKING ABOUT IT. Folks, I'm afraid that what it is going to take for the powers to be,
> To start listening and to stop all this nonsense is to actually repossess a limb or two and watch the sparks fly. I'm sure you will be able to point your disappointed patient in the right direction once you explain why you are taking this unethical drastic measure.
> ENOUGH IS ENOUGH! We can't keep taking it in the shorts with a smile on our face. Drastic action is needed and needed now.
>
> I'm just saying.
>
> Be Well,
>
> Mick Holm, CPO, LPO
>
> > On Jan 25, 2014, at 10:42 AM, Jessica Longoria < <Email Address Redacted> > wrote:
> >
> > We received a claim denial (PRE PAYMENT) from Medicare. We dispensed
> > bilateral prostheses and the ZPIC auditor is stating they are not paying
> > because the physician who signed the detailed prescriptions signed an
> > attestation in 2011 stating she would not prescribe prosthetics. T*his dr
> > is on the pecos list on cms.gov < <URL Redacted>>, she does have an NPI and
> > it also states she is eligible to prescribe DME. *The ZPIC auditor states
> > there is a secret list suppliers *do not and can not *have access to with
> > physicians who have signed this attestation. So in other words, we take a
> > HUGE gamble on providing pricey services and we may not get paid if your
> > referring dr is on this secret list. ZPIC states *this list is separate
> > and diff than the PECOS list*. We can not prevent this claim denial in the
> > future without having access to this info.
> > The zpic auditor emailed this form to the dr's office to complete. The
> > dr's office tell us they immediately completed the form and 100 % sent it
> > to the auditor.
> >
> > Now, the re-consideration has been denied because they are stating the dr
> > did not sign this form (even though the dr corrected it). So now we must
> > go to an ALJ hearing.
> >
> > Has anyone had experience with this type of denial? I would appreciate any
> > input or guidance.
> >
> > Also, we have spoken with the patient. He is willing to return the
> > prostheses, go to a new dr and obtain a new detailed rx and documentation.
> > We will re deliver the legs and then rebill. Has anyone done that?
> >
> > I am currently waiting for over 2 years for an ALJ for another audit and am
> > not willing to wait 2 years on a pre payment audit. I would like to figure
> > a way around this! This is just unreasonable and un-American of our lovely
> > government!
> >
> > Thanks!
> >
> > Jessica longoria, CMF, CP
> >
> > --
> > *Jessica Falknor Longoria*
> > *Centers for Mobility/A Touch of Pink*
> > *7777 Southwest Freeway 107*
> > *Houston, TX 77074*
> > *713-773-0969*
> >
> > *www.CentersForMobility.com < <URL Redacted>>*
> >
> >
Citation
Leslie Roberts, “Re: zpic denial/dr attestation,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/236013.
