Dear List,
I need your help. I received an order from a physician, an orthopedic surgeon, for a post op ROM
knee orthosis. the patient, a medicare beneficiary was located in a
rehabilitation facility and sustained a femoral fracture. She was not scheduled
to leave the facility and was not a resident for long enough to enable me to
bill medicare. I called the facility, asked for a purchase order and received
one verbally. I supplied the cost of the device as well as the L code. After I
delivered the orthosis a very angry person called from the administration
office, she accused me of not delivering the orthosis. I informed her that the
patient was presently wearing my brace as I had just performed a follow up. She
quickly changed her complaint to include that I did not deliver the orthosis “at
the facility” to which I replied that her employees could verify that I had been
there and asked her if she checked with them prior to accusing me. She then
stopped accusing me of not delivering the orthosis and proceeded to accuse me of
not getting a purchase order prior to delivery. I informed her that I had spoken
with someone in administration prior to delivery, who indicated that he was
authorized to provide a purchase order and asked that she quiz the other
employees to find out what happened. She hung up, we followed up in a week, and
were assured that the bill had been processed. further calls were not returned
and no payment was provided. At present we were finally able to contact several
people at the facility and this person is the one who is responsible for
processing the payment. she refuses to pay for the brace, she now says that we
did not receive an auth, she has had her underling lie stating that he had never
spoken with me and had never supplied a PO. She also stated that the physician
does not have a?oprivilegesa?? at the facility and they would not honor the
prescription.
I was hoping that someone would know who at medicare I could
contact to report this matter, and who in Florida I could contact for assistance
as well. I thought that these facilities were required to pay for any DME and
OandP items that were required for medicare beneficiaries in their care within a
specific window. Have any of you had similar issues in the past, if so how did you
rectify the problem?
Thanks in advance,
Herb Smith Jr. LPO
