CMS Prior Authorization Proposal
Wil Haines
Description
Collection
Title:
CMS Prior Authorization Proposal
Creator:
Wil Haines
Date:
6/14/2014
Text:
Hello Colleagues and Guests,
I believe Nicole's post regarding DMEPOS prior authorizations is
important. However, as I read through the proposed CME prior
authorization system, it is apparent to me that this is merely a
band-aid fix for a much larger and more serious problem and I believe it
will likely prove to be unsuccessful.
Virtually all federal government systems have essentially run a-muck and
until those systems are brought back into balance, there is little hope
for meaningful change within the CMS or any other federal government
system. Folks, we have a very serious problem on our hands in this
country and unless we belly-up-to-the-bar and help get our government
back on track, nothing of essence will happen anywhere within the halls
of government. That can best be accomplished by voting appropriately in
November. But even if a responsible group of people is elected, keeping
those folks from being tarnished by the 'inside-the-beltway poison
after election will still be daunting. There seems to be some magical
potion in DC that corrupts virtually every elected official and their
accomplices. Sorry, but that's the way I see it.
In the meantime, we should all read the proposed prior authorization
document and comment on virtually every line that needs to be fixed. For
starters, in my opinion nothing short of POS separation from DME will be
promote or allow a solution to the fraud and abuse claim of CMS. Without
such action, CMS can install all the fixes they can dream up, but none
of them will work without this separation. Why is this issue so
complicated for those within the ranks of government? Is it because
special interest monies are driving the system? Given the actions of
those in command at CMS, I find it hard to believe that this is not the
case.
For better or worse, and I've had a lot of worse lately, I plan to
publish my comments that will be reported to CMS. At this point, there
is little to lose and much to gain by going public with our criticism.
My patients are even starting to chime in with what can I do to help?.
They too see the injustices that are occurring within the comprehensive
prosthetic and orthotic system. Many of them also believe this is
largely because of misinformed and misguided federal agents.
Summarily, I believe this will ultimately end up being a bad idea. In
the beginning, it sounded like a good idea to me, but after witnessing
the logic and associated actions that spew from within CMS and its
associated auditing systems, I have changed my mind. To fix the problems
that CMS believe exist, they need to separate POS from DME, eliminate
off-the-shelf systems that do no require the services of a professional
orthotist or prosthetist, and hold the professional orthotist and
prosthetist accountable for their actions, just like they do every other
health care professional. Amen? Amen!
Wil Haines, CPO
Bionic Solutions
Avon, IN
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Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
I believe Nicole's post regarding DMEPOS prior authorizations is
important. However, as I read through the proposed CME prior
authorization system, it is apparent to me that this is merely a
band-aid fix for a much larger and more serious problem and I believe it
will likely prove to be unsuccessful.
Virtually all federal government systems have essentially run a-muck and
until those systems are brought back into balance, there is little hope
for meaningful change within the CMS or any other federal government
system. Folks, we have a very serious problem on our hands in this
country and unless we belly-up-to-the-bar and help get our government
back on track, nothing of essence will happen anywhere within the halls
of government. That can best be accomplished by voting appropriately in
November. But even if a responsible group of people is elected, keeping
those folks from being tarnished by the 'inside-the-beltway poison
after election will still be daunting. There seems to be some magical
potion in DC that corrupts virtually every elected official and their
accomplices. Sorry, but that's the way I see it.
In the meantime, we should all read the proposed prior authorization
document and comment on virtually every line that needs to be fixed. For
starters, in my opinion nothing short of POS separation from DME will be
promote or allow a solution to the fraud and abuse claim of CMS. Without
such action, CMS can install all the fixes they can dream up, but none
of them will work without this separation. Why is this issue so
complicated for those within the ranks of government? Is it because
special interest monies are driving the system? Given the actions of
those in command at CMS, I find it hard to believe that this is not the
case.
For better or worse, and I've had a lot of worse lately, I plan to
publish my comments that will be reported to CMS. At this point, there
is little to lose and much to gain by going public with our criticism.
My patients are even starting to chime in with what can I do to help?.
They too see the injustices that are occurring within the comprehensive
prosthetic and orthotic system. Many of them also believe this is
largely because of misinformed and misguided federal agents.
Summarily, I believe this will ultimately end up being a bad idea. In
the beginning, it sounded like a good idea to me, but after witnessing
the logic and associated actions that spew from within CMS and its
associated auditing systems, I have changed my mind. To fix the problems
that CMS believe exist, they need to separate POS from DME, eliminate
off-the-shelf systems that do no require the services of a professional
orthotist or prosthetist, and hold the professional orthotist and
prosthetist accountable for their actions, just like they do every other
health care professional. Amen? Amen!
Wil Haines, CPO
Bionic Solutions
Avon, IN
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Citation
Wil Haines, “CMS Prior Authorization Proposal,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/236369.
