Dear O&P friends – I strongly, strongly encourage
each of you to schedule a meeting with your Congressman today (and Senator if
you can) to discuss this 2 year ALJ delay! I met with my Congressman last week
and he was very favorable toward our cause… but he is only one of 435! Every
Congressman needs to hear the same message if we are to expect any change. A
few of us cannot bring about change – everyone needs to act. (Think of all the
fish swimming down at the end of “Finding Nemo” to be freed from the
net.) You do not have to travel to Washington DC – Congressmen and women
regularly meet with business folk in the districts they represent, but you have
to get on their calendar. Below is text from my written brief for my
Congressman prior to our meeting. Feel free to use it. We must all act together
if we are to secure our future ability to serve amputees! – Joe Huntsman, CEO Southern Orthocare
The area of greatest pain for the
O&P industry is the sweeping RAC audits.Industry leaders are currently
working on legislation to protect qualified providers from unfair RAC audit
practices, but it has not yet been introduced.In light of RAC audits, the
Office of Hearings & Appeals (ALJ) is overwhelmed with 15,000 new cases a
week. They are implementing a two year moratorium on new appeals.This will bring further
devastation to O&P providers.CMS recoups reimbursement that they deem as unnecessary after the
“reconsideration” second level of appeal (which is a rubber stamp for
CMS and provides no objectivity for providers).When cases finally reach an
ALJ judge (the third level of appeal), the majority of denials are overturned
in favor of providers.The ideal solution to this
problem would be a new bill that requires recoupment of funds to not take place until after the ALJ decision.Would you consider introducing
a bill that does this as a single issue?This would bring great relief
to providers! CMS is making it very difficult for healthcare providers to have
access to due process.
