I would like to respond to Doug Harrison’s letter to the editor "Warning shot" (see below). I am on the side of those who think the PMD demo is working in as much as it does give the provider some assurance that their claim is not technically flawed in some way before the equipment is delivered to the customer. If a prior authorization process helps keep expensive claims out of audit hell, it’s a good thing. Utilization may be down, but legitimate utilization is probably no better or worse than it ever was. What’s important is that what’s provided through the Medicare program gets paid for and stays paid for.
Mr. Harrison has a lot of gall to warn us about the “sadistic pain and suffering inflicted by CMS.” Overly aggressive advertising and abusive business practices by some in the business exploited Medicare beneficiaries and led directly to the punitive regulatory environment everyone else must now live with. Notoriety surrounding the fall of the Scooter Store has been used by industry critics to damage the credibility of everyone in the power mobility business.
Please think hard about this warning! In the March issue of HME News, industry stakeholders proudly state that the “PMD demo is working” (page 19). What do they mean by “working”? Utilization is down by 69%. A substantial number of other articles in the same issue (and every other issue for the last few years) describe, in horrific detail, the sadistic pain and suffering inflicted by CMS’s various audit schemes. So, what do the PMD demo and these schemes have in common? The PMD demo allows Medicare to inflict all of the same ridiculous and sadistic “standards” on all claims before they’re processed. It’s no surprise that utilization is down by 69%. The big surprise is the industry and the press keep celebrating this as a success. Please watch out for prior authorizations coming to any other product categories! Imagine the joy of having to pass 100% of your business through the irrational hurdles of today’s punitive audit environment. You might be lucky to have 31% of your claims survive. Is that enough for your business to survive?
—Doug Harrison, founder, The Scooter Store