zpic denial/dr attestation

zpic denial/dr attestation

Jessica Longoria

1/25/2014

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>>*