The tale of the three CSRs


I have a good idea for a study by the Office of Inspector General (OIG) or the Government Accountability Office (GAO).

How well-versed are Medicare’s customer service reps (CSRs)?

I got an email from a provider last week who recounted a story about how he has been unable to pick up the wheelchair of patient that had reached 10 months on a 13-month rental, despite that patient being admitted into a skilled nursing facility (SNF) permanently.

When Kyle Hoffman at Anderson’s Medical Products notified the patient’s daughter that he would need to pick up the chair, she was reluctant. She said she uses the chair to take her mother to lunch on occasion.

No problem, Hoffman told the patient’s daughter, if you complete the rental on the chair as a private pay, you can keep it.

She didn’t want to do that and agreed to release the chair the following day.

But five minutes before Hoffman was supposed to pick up the chair, the patient’s daughter called and told him that she had been on the phone with a CSR at Medicare and the CSR told her that the provider could not pick up the chair without a discharge order from a physician.

The CSR told the patient’s daughter, according to Hoffman: “It’s a life-sustaining piece of equipment and, regardless of the client’s SNF status, (not having it) would put her at risk.”

That didn’t sit right with Hoffman. So he called Medicare and spoke with a CSR who told him, no, what really needs to happen is that the SNF needs to change the patient’s status from SNF to a permanent resident.

This CSR said, according to Hoffman: “Once the process is complete, you will be able to obtain your last three payments.”

This didn’t sit right with Hoffman, either. So he called the line again and spoke with a different CSR. This CSR agreed with him.

“I then requested that someone from Medicare call this client’s daughter, apologize and explain that she had been misinformed,” he wrote. “Of course, I was told Medicare will not do that.”

So Hoffman is currently out a wheelchair that did not meet purchase point and he has Medicare to thank. Why doesn’t he call back the patient’s daughter and explain what Medicare should have explained in the first place?

Would you?

“It seems as though Medicare uses the term ‘fraud and abuse’ quite loosely,” he wrote. “However, when the shoe is on the other foot, they love to claim immunity.”