This is the most useful, and probably important, message that I seen yet
coming from the National Office. This is precisely what makes the internet
and our National organization useful for moving O&P in a positive direction.
I would bet that there are practitioners and/or business persons out there
who would be willing to show up on some congressman’s doorstep with a client
(patient,) if necessary, to support change for the ridiculous Medicare O&P
policies and laws that have recently been adopted. I still maintain that
our most effective weapon in fighting our cause is with individual cases
that are presented to our Congressmen at their local offices. Compiling and
actively monitoring a database at our National Office to track and report on
such activity would give O&P facilities something to compare with and and
would likely spur others to actively participate in such matters.
I recently took a Medicare case to a fair hearing and lost. The dollar
amount was less than $500.00, so my only option was to consolidate this
claim with another provider and present it before an administrative law
judge (ALJ.) However, Medicare would not tell me who another provider was
that had claims to present before an ALJ. So the fair hearing was the end
of the road and because the hearing officer misread the medical record, my
case was denied. As a result, I took the matter to Congressman Souder’s
office. While I still have not won this case, I have been informed that
Medicare is going to reopen the case and let me have another fair hearing.
Supposedly, that does not happen often. There is little doubt in my mind
that my case was denied because of previous Medicare abuse for the device in
question. But, the fact that there are some unscrupulous providers who are
abusing the system should not be a reason for Medicare to deny legitimate
services that are covered by Title 42 Code.
Can we afford to fight such cases? If we don’t, we are what we are.
Wil Haines, CPO
—– Original Message —–
From: Robert VanHook
To:
Sent: Friday, April 30, 1999 4:21 PM
Subject: U.S. Politics: SNF atrocities
> As you know the Balanced Budget Act established a prospective payment
> program for Skilled Nursing Facilities. Now, some members of Congress are
> beginning to wonder if it was a good idea to put SNF administrators in
> charge of the care for Medicare beneficiaries.
>
> AOPA is pushing to eliminate SNF/PPS for O&P services. We need your help
> in identifying cases in the field. Please let us know of instances where
a
> SNF deliberately refused care to Medicare Part A resident patient in order
> to postpone the care and ensure that Part B would be responsible for
> payment upon discharge. What was the result of the SNF’s postponing the
> care? Do you have any other stories of SNF atrocities?
>
> If you do not want to make your case known, please feel free to respond to
> me directly
> case without your specific permission.
>
> Thank you for your support in this important matter.
>
> Bob
>
> Robert T. Van Hook, CAE
> Executive Director
> American Orthotic and Prosthetic Association
> 1650 King Street, Suite 500
> Alexandria, VA 22314
> Phone: 703/836-7116
> Fax: 703/836-0838
> Email: [email protected]
> Webpage: www.opoffice.org
>
