Letters to the editor: Reform creates problems

Monday, May 24, 2010

This is in response to "ZPIC: The newest acronym to strike fear in providers" (HME News, March 2010). Every day the agency contracted by Medicare to carry out audits sends us letters automatically denying claims for payment submitted by our firm until all documentation is provided to them within 30 days. Then we must await payment for 90 to 120 days.

The information they request includes: progress notes, medical history, pictures of service, purchase invoices, etc., which sometimes represents more than 50 pages of documents.

We have to do all of this without any prior history, on our part, of any fraud. We have run a clean business for over 12 years.

To provide this documentation, we encounter a lot of problems:

•    Doctors' offices don't have the time nor the personnel to stop their jobs and start making copies for us of patient records/histories. They consider this an unnecessary burden and, consequently, they prefer to do business elsewhere.

•    The hospitals' medical records departments also face the same problem, in addition to the fee that sometimes they require for the service of providing records.

We firmly believe that the purpose of this "100% Payment Process" audit is to put an economic strain on us, as well as on all of the other providers to make our businesses impossible to operate, thus serving Medicare's goal of having fewer providers.

Small companies placed out of business will not only affect the owners but also will mean fewer jobs and, more importantly, less personal care for the patients, who will be the most affected part of this equation.

It should be the government's task to inspire innovation and entrepreneurship instead of growth in corporate America. Reforms like this create a new whole set of problems in the Medicare system.

- Carolina Ferreiro-diaz, CEO/Owner, Pharma-Express, Miami

Testing at home is way to go

I am a case manager in an acute setting. Discharging my patient home is sometimes delayed due to problems qualifying the patient for home CPAP. I am happy to see that CMS will consider home-based testing. Not only is it a sane, patient-focused decision, it could save the Medicare system some money. CPAP and Bi-Level are therapeutic interventions that help keep people at home and out of the hospital.  Compliance with CPAP and Bi-Level is improved with nasal pillows. I hope, but do not know, if Medicare will cover this option.

- Linda Pickenpaugh, R.N., case manager

What's good for Medicare isn't good for providers

I am responding to the editorial "CMS: Master of the double standard" (HME News, April 2010). I am appealing a silly wheelchair problem all the way past the administrative law judge (ALJ). It has been a colossal waste of time, but I am stubborn. Here is the gist of the letter I received from the Department of Health and Human Services:

We have received your request for review of the Administrative Law Judge's decision in this case.

However, due to our current workload, it may be some time before the Medicare Appeals Council can act upon your appeal. When the Council does act upon your request, you will be notified of the action taken.

We had deadlines we had to meet every step of the way, and we made sure to meet them.

Thought you might find this interesting.

- Gary Rench, owner, Sandcreek Medical, Sandpoint, Idaho

Fight to get paid

I thought the editorial "CMS: Master of the double standard" (HME News, April 2010) was very well written. It is so frustrating to see good local DME companies trying to do the right thing, all the while, being raked over the coals by CMS. It's enlightening to see your publication bring these issues to the forefront in this industry that has become 40% helping people, 60% fighting to get paid for it.

- Andy Campbell, ATP, Sr. Rehab Product Specialist, Pride Mobility Products Corp., Quantum Rehab

Take advantage of the ABN? "ye, you can,' says Mal Mixon

I was excited to read the article, "Providers turn to ABNs for upgrades" (HME News, April 2010). More than 10 years ago, Invacare spearheaded the legislation necessary to allow beneficiaries to choose to obtain upgraded items by using the ABN process. At Invacare, we've always believed that consumers should have the right to choose the product that will best serve their lifestyle needs if they are able to make up the difference between what is owed and what Medicare will pay for. Being able to shift their product choice from need to want is an important part of Invacare's "Yes, You Can" philosophy. Making sure consumers have access to the features and functions that they need to live their lifestyles to the fullest is even more important as reimbursement continues to be reduced.

While consumer choice is important, providers must be mindful of the detailed Medicare billing rules that are applicable to each patient situation. Within the policy and funding section of the www.invacare.com/homecare Web site, you will find a detailed ABN upgrade sheet that will walk you through the process.

Homecare products allow beneficiaries to live life better. Help them understand the many available options that they can access through the ABN upgrade process. We believe that many consumers don't take advantage of the many HME product options that are available to them. The ABN process enables HME providers to showcase the variety of products and their many features and options. I hope more HME providers will help their customers take advantage of the opportunities that exist through the ABN upgrade process.

- Mal Mixon, CEO and chairman of the board, Invacare