Letters to the editor: Prior authorizations: 'A simple fix'
In "Who's on the hook for wheelchair repairs," HME News, March 2011, it is mentioned that Medicare should go to a prior authorization vs. prepayment review. This is a question I have asked for years.
On every insurance that we carry, before we deliver any item it gets a prior authorization except for Medicare. It seems by doing this step it would eliminate much of the fraud and abuse of the Medicare system.
All of the HMOs we work with require a prior authorization before delivery on items that will be more than $100, including rental of equipment. So my question is why does the government ignore a system that works? Many times the patient gets the equipment, including power chairs, faster than they would if they were on Medicare. We usually get the documentation, submit it and have an authorization or denial in two to three days on power chairs. On most other equipment, usually same day if not next day.This seems like a simple fix. I cannot believe that doing this would cost the government more money than using a messed up, confusing system such as competitive bidding. They have the staff in-house; it should be easy enough to transition to prior authorizations from prepayment reviews with proper training.
With the inclusion of accreditation, surety bonds and new supplier guidelines, this change of operation would seem to save the industry and Medicare money by eliminating fraud, repealing the need for competitive bidding and eliminating uncertainty on payment to the provider.
Thank you for your time, as well as all the great and informative articles.
PRN Medical Services
The government has the wrong target
I read an article about a Medicare fraud bust involving doctors and I was wondering why our industry isn't using these issues to prove our point. We all know that the DME industry has been targeted by Medicare to reduce costs and they have targeted us for fraud. We know how competitive bidding and all the changes to respiratory and power mobility LCDs have really hurt the industry and Medicare claims it's to reduce fraud and abuse.
Knowing that we are small fish in the Medicare pond, why isn't there a bigger push to make Medicare look closer at the fraud involving doctors? I'm sure Medicare could recoup a heck of a lot more by increasing these types of targets than by taking it away from our industry.
Here is a quote from the article: "Federal authorities charged more than 100 doctors, nurses and physical therapists in nine cities with...illegally billing Medicare more than $225 million."
If only 100 doctors, nurses and PTs billed more than $225 million, how many more doctors, nurses and PTs across the country are doing the same thing?
If you use Medicare's normal game of "extrapolating," the dollar amounts would be enormous. It makes our industry pale in comparison.
Again, why isn't our industry using these facts to help prove the amount we bill is peanuts compared to the fraud and abuse in other areas? If CMS wanted to really save money, these are the "targets" to go after, not our industry!
-Dave Simms, ATP