I was wondering if anyone else on the server is experiencing what appears to be a strong arm tactic by Medicare , and some of the insurance companies to do Random probes.
Medicare Dmerc Spring 2004 update . states that:
Prosthetic socket replacements on previous wearers Above the kneeBelow the knee Custom AFO’s .
Custom Knee
The information which is being requested in most cases , is information we as practitioners have no control over. The physician is documenting a custom knee brace, the doctor had been called to see if an off-the-shelf knee brace would work and still wants custom and now should Medicare’s advisers feel this is not necessary . we are unable to be reimbursed by the patient or by Medicare , unless of course , now if we were smart enough to have the patience sign and ABN up front, in which case having patience sign ABN has a routine practice is illegal . we have a chance to collect from the patient is the patient has funds available.
When it comes to previous prosthetic wearers and not only do they require documentation of physical changes , which is appropriate. But this now will get thrown into Random probe , which will delay the payments between 90 and 120 days.
Does anyone know if any of our national Association’s are having discussions with CMS . I am sure that this is not a regional problem . since this was issued in the DMERC.
It is my opinion that this goes back many years ago , when we were classified as DME vendors and not considered healthcare professionals. So the question is why do we pay dues, why do we support our national Association’s and why have they had their head in the sand for so long. What the problems which are facing our industry and have been for quite sometime until the time comes .
when we are respected and considered healthcare professionals rather than DME salesman . we do not have a chance at continuing to exist as a profession as we will be swallowed up by other” he healthcare professionals .”
if you have any feedback . I look foward to hearing some other opinions.
Jan Saunders LPO, CP
