Sunday, May 29, 2022

Medicare post-payment audits

John Wallace, CO

This is an open letter to all,

I have just read John Michael’s article “Common Sense Doesn’t Apply” in the Sept. 15 issue of O&P Business News and I’m feeling very disheartened. I have a small business and take pride in offering a high level of service and in always doing right by my clients and referring sources. One of the reasons that I entered this field was the opportunity to positively impact the courageous lives of those who are disabled or chronically affected by injury of illness.

I’m located in DMERC Region C and am already overwhelmed by the amount of non-payments and denials for for reasons like “payor deems the service is not a medical necessity” and “information submitted is inadequate to support this level of service.”

Running a business in this field is difficult at best, and lately has, at times, become a nightmare. I guess I’m posting this letter to find out how many others feel this way and what are others’ experiences in this present unreasonable regulatory climate. Has it gotten bad enough that businesses are shutting down and practitioners are leaving the field? What is being done at present to counter these trends and are present initiatives effective?

I invite you all to weigh in with your thoughts and opinions. Frankly, the solution to the current situation seems bigger and more complex than I alone can solve.

Keever Wallace, CO

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