Summary of Returns

Summary of Returns

Paula Pivko

10/29/2014

Here is a summary of my responses to my question about returning a custom device. Many asked me to post responses. Thanks to all who have responded. People we spoke to advised taking pictures, noting the condition of the prosthesis when or if returned and having the patient sign a return receipt. We have all our clinicals and are awaiting any possible notification from Medicare. Paula Martinek, LPO
Believe me you do not want Medicare on your front door if this guy complains. Attorney fees are much higher. Take the high road and return the money , it hurts but does not worth the head ache.
First of all, if you believe you provided a product that the doctor ordered& it fit and functioned appropriately, you have every right to bill for theproduct.You are NOT required to issue a refund unless, and until, Medicare requiresit. You may never actually hear from Medicare regarding this.If you do get a request for a refund, you still have appeal rights. You needto provide documentation to show the medical necessity of the device, thatyou provided the device that the doctor ordered and that it was fitting andfunctioning appropriately.You are not required to contact or notify Medicare that the patient wishesto return the device. You also are not required to accept return of thedevice, if you believe it was appropriate. I spoke directly with MedicareCGS Administrators Provider Outreach earlier this year about this exactissue. I was informed that, per Medicare supplier standards, we are onlyrequired to accept returns of substandard or less than acceptable items.This does not sound like a policy issue, but rather a patient complaintissue.We has a somewhat similar case a few years ago. Patient got custom bilateral KAFO's. We made them as he wanted, made several adjustments to them, then he came in and said he didn't want them, left them with us and wouldn't come back, said they weren't what he wanted. Turns out he had been through several other area providers and was never happy. He did call Medicare and complained, wanted them refunded because he wanted to go to someone else and with 5 year rule couldn't get another set without cause. We had documented very thoroughly all conversations and communications with patient, provided Medicare all the records. We were able to show that he was non-compliant, didn't allow us opportunity to adjust or remake if needed because it was within the 90 day warranty. Medicare did not make us refund money because we didn't do anything wrong and made appropriate attempts to solve any issues. If the patient is difficult and not cooperative or compliant you shouldn't be liable. It will depend on your documentation and the reasons he wants to return it.To my understanding, outside of the 90 day warranty you are not required to make refund. If the patient insists upon returning the prosthesis you must take it back (keep it in it's returned state, label it,etc) and provide a return receipt to them. Should you get audited or a recoupment request from Medicare I would fight it (providing all your documentation is in order- rx, delivery receipt, instructions for use, any clinical notes during 90 day warranty period). Your obligation to the patient (with Medicare as the payor source) was to provide prescribed device and follow up care for 90 days. As long as your documentation is on order and you show efforts to resolve the patients complaints in the 90 day period ( obviously I'm assuming of there were complaints or concerns vocalized they were addressed. ) them I don't think you have much to worry about .We had this issue last year. pt wore test socket setup for use at home for 3months then auth'd completion. Initially, goal was to see if new socket would heal a wound. Then it became issue that pt would cancel follow up appts. Finally got him in. Wound was healed. Sent duplicate of pt model to c-fab ( his alignment was close to bench), pt came in for delivery after several cancelled appts, took receipt of device w/no complaints of comfort or alignment, skipped routine 2wk f/u & his clinic appt, kept claiming no issues when we were able to speak on the phone (left numerous messages w/wife), few months later his wife shows up w/Px, custom liners & supplies -returning everything claiming it did not fit!!!!? At this point pt had worn this socket shape & alignment for 7.5months! We did not refund...documented everthing thoroughly throughout this process. Had no issues w/insurances. Still have pt's Px & supplies bagged & tagged b/c it's his property. Plan to & told him it will be held for 3yrs then donated overseas. As long as you document how things played out including phone calls & follow up visits...& it's obvious of your good faith attempt to make things right for pt, & pt was informed of your warranty process, past 90days...no refund.Some folks it doesn't matter how far you bend over backwards for them they will not be happy.Hope this helps. ps: I almost always include a quote or paraphrase something pt said during visits. Something that shows their demeanor or personality. Reminds you of how visits went & gives readers small insight to pt w/whom you dealt.