Friday, May 27, 2022

Here’s one for you


 So we all know that we can call Medicare & other insurances to verify the individual is covered, or currently on their roles.  For some reason, however, we cannot call to verify that the person standing in your office, presenting themselves with the prosthesis you made them, wearing the liners & supplies you provided, asking AND apparently needing new liners & socks due to normal wear & tear (was over a year since receiving them)…you cannot call to see IF they have received these items somewhere else in the last year?????!   Fortunately, we tried and the person on the phone asked to speak to the individual in question.  He was asked to speak with the insurance representative to verify his eligibility for the items in question and did.  The insurance representative then informed us that this individual had just received all of the items he was requesting PLUS an torsion adapter in APRIL 2013!!!!!

He then went ballistic telling us that a local DME provider (not prosthetic) must be billing fraudulently.  That he never received these items.  He even called Medicare himself, got a recording detailing charges made for these items and the date of service.  He had this on speaker so we could hear WHILE he was claiming fraud by this other company!   We denied services this time & referred him back to whomever provided these items/services.

If we had not have called, had not had received the patient’s authorization to obtain information, we would be out a great deal of money.  WHY are there no rules in place to protect the providers????!  WHY are WE always looked at (by our government) as the thieves?!  This gentleman can go to any area provider wearing his very old (from how many yrs ago now?) liners & socks, make up some sob story, get these items and the provider is out of luck.  Even is an ABN is signed, some folks do not pay.  Even when they “go to collections”, they don’t pay.  How many Attorneys fees do we have to pay to pursue these people? How many hours are lost trying to recoup?

We should be able to obtain information about what patients have received and when…so that we do not duplicate services. 

My Friday soapbox.

Rick Milen, CPO, PTA
Prosthetic Specialists
West Lawn, PA


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