More Information about Delivery Tickets

More Information about Delivery Tickets

Jim DeWees

6/12/2015

Hello Again,

Thanks for the replies so far. It is very interesting.

As for now, we are NOT delivering any more limbs or services for anyone with
Medicare. It is very unclear about what is required to have documented on
the Delivery Ticket, I spent HOURS on the phone with level 1 and level 2
representatives and had NO good information from either of them. The
manager from Level 2 called me, and again NO help or instructions were
available.

I did speak with the Medical Director today (I was able to reach her by
phone), and she is reviewing the case right now, and looking over my claim
and delivery ticket.

The only information that I was given was that simply stating the HCPS code
language is NOT sufficient. I asked about WHAT MORE do we need to explain?
What more do I have to say about about the Check Socket code? Do I really
need to write an explanation about what a Test Socket is? What level of
understanding or education does the reviewer have regarding prosthetic
limbs? Do I have to write a description about what a Check socket is? She
could not answer that. I asked about what more to say about Ischial
Containment/ Narrow M-L design? Do I have to write a definition to
explain the basic principles about what that means? Will the reviewer even
know what the term Socket is? Again, she did not know what to say or
could not answer this question. She is going to research this and get back
with me....but it won't be next week, but maybe the following week.....

I honestly have NO idea about WHAT we must have on the delivery ticket. I
DO have the part number, make and model of the knee unit, and also the make,
model and serial number of the foot. The packing slips from the
manufacturer with the liner information, which has the patient name on the
packing slip from the manufacturer was submitted as well with the audit
packet. BUT this was still NOT ENOUGH!


I told this Medical Director that until I have some clarification and better
information about WHAT they are requiring and expecting, and some Best
Example to follow, I will not be providing or delivering ANY prosthetic
limbs to my Medicare patients. There are going to be several very upset
amputees here. They are welcome to go to another facility and start over
with the other facility. I cannot afford to work my self to death, only to
run my business into the ground because of these new policies. I will let
another facility work their own business into bankruptcy if they are willing
to do that. Let some other facility pay for the parts and materials,
provide the labor and all the work, and let them GIVE this all away and then
try to fight for the payment for years.... and with NO set rules or concrete
information about WHAT is required, it is doubtful that they will ever win
the appeal or get paid.

Of the emails that I have received, many said that they are also suspending
ALL medicare work at this time as well.

My other question was: WHY did Medicare/CMS or whoever spend so much time
and energy to come up with these descriptions and definitions for the HCPCS
codes? Why do these definitions exist now that we are all NOT supposed to
use them for our billing or claims purposes? Does this make ANY sense for
the government to create this very detailed description of the codes and
services, and then forbid the providers from using these definitions in
their billing process? How crazy is that? WHY have these definitions? Or
why are these definitions not considered adequate? Why are we NOT supposed
to use these?

I understand CMS wanting part numbers, or models, brands, and even serial
numbers. I can understand and appreciate the concerns about facilities that
are re-using feet, knees and other components that were previously paid for
and were provided to a different patient who no longer needs them. Medicare
also wants to make sure that if we are billing for a specific type or
category foot, that the patient is actually getting a foot that is in that
category. BUT what they are doing now is just beyond stupid, in my opinion.


Anyway, if you have NOT had a denial YET for having an unacceptable delivery
ticket signed by the patient, I can guarantee that you WILL have a denial of
these delivery tickets. From my understanding, EVERY audit that was
reviewed so far in June has been DENIED based on an unacceptable Delivery
Ticket. I guess the phone lines are FLOODED right now with complaints from
providers and questions about WHAT is going on!!!

I hope to be able to get this resolved quickly, and it seemed to put a sense
of urgency to this when I explained that I cannot provide or deliver any
more devices or services UNTIL we get this corrected. I cannot afford to
ruin my reputation or being compliant and thorough and my passing rate
just because there is no clear language or explanation of WHAT they require.

The medical director personally could NOT provide any information or help to
educate me on this....she did not know herself about WHAT would pass this
new standard that they are using.

I am waiting for a Provider Outreach Education conference call to hopefully
explain this.

So, BEWARE and understand that ANY delivery ticket that is NOT compliant
will not pass the audit! And there is NO definition about what is
compliant at this point. It is a HUGE risk to deliver anything at this
point!

Good Luck, and please let me know if ANYONE has successfully passed an audit
with the new Delivery Ticket requirements.... I really want to know if that
is even possible.

Thanks, and have a good weekend.


Jim DeWees, CP