The unbundling of Medicare codes
Wil Haines
Description
Collection
Title:
The unbundling of Medicare codes
Creator:
Wil Haines
Date:
3/12/2014
Text:
Dear Colleagues and Guests,
Yes, I am still alive. Thank the good Lord. The Medical director of
Region A evidently does not understand how the L-Code system was
compiled and structured by Medicare. When Medicare came into being,
bills for O&P services were largely written as narratives and they did
not include a separation of codes, such as L-Codes. This was the
brainstorm of Medicare and those O&P professionals who were advising
Medicare at the time. From the beginning, Medicare was based upon an
add-on system, period. Otherwise, the fee structure for O&P services
would have to be totally revamped and restructured. As a side note, why
is it that physician's offices charge for such things as injections, lab
tests, etc., as separative entities, as opposed to having them all
bundled in the clinic visit? For similar reasons, O&P services were set
up with add-on charges because there are so many different
configurations for the same or similar services in O&P. For example, one
CVA patient might require extensive O&P care and services, while another
CVA patient requires no or minimal O&P care. The same is true for
amputation cases. We could go on about this for a long time.
As far as I can remember, when Medicare came into being, Acrylic,
Titanium, and a host of other chemicals and materials were not readily
available in the O&P profession. Prosthetic sockets, which Medicare by
the way, still makes reference to the open end socket, were often still
made of wood and wrapped with polyester resin. And yes, at a point in
time, there were plenty of open end sockets made which simplified the
fitting process, but often not without consequences. If we were still
making lower limb prostheses this way, the basic cost for a prosthesis
would be considerably more expensive than today's modern O&P systems,
due to the labor involved alone. The same is true for orthopedic braces.
Treating metal with fish-oil technologies using a carborizing flame with
an acetylene torch or sending parts out to the nickel plating companies
would cause the fees to be astronomical for these services today. Add
custom fabricated knee joints and sidebars with forged locks and the
costs just keep going up and up and up. Add the laboratory space once
required to provide such care and, well you get the picture. The federal
government, using their own labor numbers would not be able to refute
what I am saying. Each and every time a patient came into the office for
repairs or adjustments, it was a BIG deal, labor-wise. Improvements in
O&P technology and materials is really no different than say the
automobile industry. All of the safety and other technological
improvements that have occurred over the last several years have not
decreased the price of an automobile. As with O&P devices, the price of
an automobile continues to climb each year to reflect, not only the
improvements in technology, but also the added government regulations
and administrative details that are required. Sound familiar? Our case
is no different. So if Medicare wants to sit down and re-evaluate the
manner in which O&P services are rendered and priced, I think that would
be wonderful, provided we use government numbers. In other words, lets
use labor and other statistics that the federal government uses in its
own operations to determine what the fees should really be for O&P care.
I think the Region A Medical Director would be surprised to find that
today's Medicare O&P care is a bargain, compared to the same services
offered by and within, for example, the federal government. Why is it
that the number of ICD-10 have increased as they have. Isn't that really
a case of unbundling? Of course it is, and it is rightful, just as the
add-on codes for O&P are.
Before we get involved with trying to rationalize our add-on codes to
Medicare, which I believe will be a mistake and a huge mess, we should
insist that Medicare read their own regulations regarding the provision
of O&P care. We did not institute the system that is now in place, they
did. Anything less than that would be, in my opinion, a direct violation
of Federal Statute. By the way, many perhaps don't know this, but the
federal government is required to provide for a fair and reasonable
profit for any federal government contractor. Otherwise, how could the
services be rendered by contractors? As federal contractors, we are
entitled to a fair and reasonable profit and we need to hold the federal
government accountable to this fact, bundled or unbundled. At this date,
such is not the case for O&P care and we need to take them to task.
Wil Haines, CPO/L
Bionic Solutions
Avon, IN 46123
Yes, I am still alive. Thank the good Lord. The Medical director of
Region A evidently does not understand how the L-Code system was
compiled and structured by Medicare. When Medicare came into being,
bills for O&P services were largely written as narratives and they did
not include a separation of codes, such as L-Codes. This was the
brainstorm of Medicare and those O&P professionals who were advising
Medicare at the time. From the beginning, Medicare was based upon an
add-on system, period. Otherwise, the fee structure for O&P services
would have to be totally revamped and restructured. As a side note, why
is it that physician's offices charge for such things as injections, lab
tests, etc., as separative entities, as opposed to having them all
bundled in the clinic visit? For similar reasons, O&P services were set
up with add-on charges because there are so many different
configurations for the same or similar services in O&P. For example, one
CVA patient might require extensive O&P care and services, while another
CVA patient requires no or minimal O&P care. The same is true for
amputation cases. We could go on about this for a long time.
As far as I can remember, when Medicare came into being, Acrylic,
Titanium, and a host of other chemicals and materials were not readily
available in the O&P profession. Prosthetic sockets, which Medicare by
the way, still makes reference to the open end socket, were often still
made of wood and wrapped with polyester resin. And yes, at a point in
time, there were plenty of open end sockets made which simplified the
fitting process, but often not without consequences. If we were still
making lower limb prostheses this way, the basic cost for a prosthesis
would be considerably more expensive than today's modern O&P systems,
due to the labor involved alone. The same is true for orthopedic braces.
Treating metal with fish-oil technologies using a carborizing flame with
an acetylene torch or sending parts out to the nickel plating companies
would cause the fees to be astronomical for these services today. Add
custom fabricated knee joints and sidebars with forged locks and the
costs just keep going up and up and up. Add the laboratory space once
required to provide such care and, well you get the picture. The federal
government, using their own labor numbers would not be able to refute
what I am saying. Each and every time a patient came into the office for
repairs or adjustments, it was a BIG deal, labor-wise. Improvements in
O&P technology and materials is really no different than say the
automobile industry. All of the safety and other technological
improvements that have occurred over the last several years have not
decreased the price of an automobile. As with O&P devices, the price of
an automobile continues to climb each year to reflect, not only the
improvements in technology, but also the added government regulations
and administrative details that are required. Sound familiar? Our case
is no different. So if Medicare wants to sit down and re-evaluate the
manner in which O&P services are rendered and priced, I think that would
be wonderful, provided we use government numbers. In other words, lets
use labor and other statistics that the federal government uses in its
own operations to determine what the fees should really be for O&P care.
I think the Region A Medical Director would be surprised to find that
today's Medicare O&P care is a bargain, compared to the same services
offered by and within, for example, the federal government. Why is it
that the number of ICD-10 have increased as they have. Isn't that really
a case of unbundling? Of course it is, and it is rightful, just as the
add-on codes for O&P are.
Before we get involved with trying to rationalize our add-on codes to
Medicare, which I believe will be a mistake and a huge mess, we should
insist that Medicare read their own regulations regarding the provision
of O&P care. We did not institute the system that is now in place, they
did. Anything less than that would be, in my opinion, a direct violation
of Federal Statute. By the way, many perhaps don't know this, but the
federal government is required to provide for a fair and reasonable
profit for any federal government contractor. Otherwise, how could the
services be rendered by contractors? As federal contractors, we are
entitled to a fair and reasonable profit and we need to hold the federal
government accountable to this fact, bundled or unbundled. At this date,
such is not the case for O&P care and we need to take them to task.
Wil Haines, CPO/L
Bionic Solutions
Avon, IN 46123
Citation
Wil Haines, “The unbundling of Medicare codes,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/236202.
