Re: zpic denial/dr attestation
TBOD
Description
Collection
Title:
Re: zpic denial/dr attestation
Creator:
TBOD
Date:
1/27/2014
Text:
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>>*
>
>
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
TBOD, “Re: zpic denial/dr attestation,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/236014.
