Discombobulated

Discombobulated:  To throw into a state of confusion.

This is how I have felt over the last few days.  Not sure why but I do and I don't like it.  I like to feel focused and I like to feel like I'm getting things done.   I feel far from both.

I was sick yesterday with some sort of bug and today didn't feel great either.

At the end of the day on Tuesday, I was at my wits end with Medicare.  I was so frustrated that I came home and wrote a 5 page letter to Medicare, John McCain, Paul Gosar, Jeff Flake, and HHS Secretary Kathleen Sebelius.  

I'm so unbelievably sick of their pathetic audits, their pathetic requests for documentation, and their pathetic excuses for not wanting to pay.

I'll post the letter when I'm finished, but here's a sample of what happened on Tuesday.  Because of wonderful HIPPA laws, I'll use a pretend name, let's call her Mrs. Smith.  

We received a request from the hospital to provide Mrs. Smith with a CPM machine. CPM stands for Continuous Passive Motion, these machines are put on patients after a total knee surgery.  It flexes and extends the leg so that the patients knee can regain motion lost from surgery.  

We have a copy of the Post Operative Orders (aka the prescription) before we leave the machine with the patient.   Insurance companies (ie Medicare) will typically pay for 21 days rental of the machine.  This 21 days starts when the machine is left with the patient.   We cannot bill the insurance company while the machine is used inside of a facility.  So, if the patient stays 2 days in the hospital, then instead of going home from the hospital, lets say they go to a rehab center like Sierra Blanca for 2 weeks, we are unable to bill Medicare for those days.  So now the patient has had the machine for 16 days.  21 minus 16 means we can bill Medicare for 5 days.  5 days for a machine they had for 21.

When we bill Medicare it is understood that we have all the required documentation on hand before the billing is sent (and we did).   Medicare denied the claim.  Now a staff member has to do all the paperwork to submit a "reconsideration request" to medicare.  With this request we send the required documents: the Post Op order (aka the prescription), the delivery sheet signed by the patient, and a pick up sheet (again signed by the patient).  Typically this is the documentation required for this type of product.

No Fraud, just a legitimate delivery by a legitimate company, because we had a legitimate prescription, because the patient had a legitimate surgery.

They deny it again.   Now they want all doctors and nurses notes from the Operation.  Really??!!!  Are you kidding me??

They may be making an effort to combat fraud, but they're also screwing honest companies in the process.  The poor little lady that we delivered the machine to is scared to death that she is going to get the bill (she won't).  

This has pretty much become the norm for trying to collect from Medicare.  I don't mind the cuts, I'm sure we'll all survive on a little less, but these pathetic excuses not to pay at all are becoming outrageous.

Last year I had to send 30 pages of documentation to justify billing for a power wheelchair that I had delivered 2 years earlier.   The patient is a quadriplegic!!!   They have the patients diagnosis on record.   I even billed less then what I was allowed to bill for. I'm not looking to get rich, but this is why DME companies are closing all over the country.  

Wanna know when things got bad.......................remember the news article I posted about the Scooter Store being raided, well that's just a tip of the ice berg.  These mail order companies that you see on TV, well they send out product every month (whether it is catheter supplies, cpap supplies, etc) to the patient whether they need it or not, then of course bill Medicare for it. It's a fleecing of the system and we're all paying for it.

So that's been my frustration for the week.  I don't see and end to the Medicare frustration, but if I give in or give up then they win and I just can't do that.

If I have time later, I'm going to post something about Competitive Bidding.  This is a program that the Medicare sees as a success, but I'll show you just one example that proves it's flawed big time.  An example that I'm sure is happening all over the country.