Thursday, March 6, 2014

Recovery Audit Contractors

I have been involved with our industry since 1950! I have never seen so much fraud and abuse as appears to be falling on innocent HME/DME  providers. CMS and Medicare have paid far too many reimbursements for fraudulent claims!
They never provided decent standards for reimbursements. They allowed payments to go to any company who submitted invoices without seeing who they may be.  Suddenly they found that they have very little money remaining. I received a notice that the “Recovery Audit Contractors" will “evaluate” the accuracy of Medicare Payments. Many of the dishonest elements, such as a group from Croatia who have all taken their stolen funds and retired out of the country, will not be easily tracked down. But the average DME dealer, who gives very good care to its clientele, (much of this pro-bono) now has to wait for their money.
“Administrative Law Judges”, appointed to investigate much fraud can be delayed for up to 24 months. The “Extended Repayment” schedules might take as long as 60 months before funds are sent. CMS will slice 3.5% off payment rates for the next four years. I saw a notice from CMS via the Affordable Care Act that they are developing an “Open Payment” program.
All of these changes I mention (and there are others) confuse me and I wonder how this affects the average provider. The time has come to accomplish many things. It’s like locking the barn after the cows have been stolen.  It is close to “too late” to make these changes, but WE MUST BRING THAT ABOUT!!!!!! The pending legislation, HR 1717, must be passed .
We have  only a few days left until the gates are opened in Las Vegas at Medtrade Spring (March 11-12). You have to be there!  AAHomecare, the State Associations, VGM the vendors, and every attendee will be working together to keep our business solvent. This cannot be accomplished unless every DME/HME dealer, every vendor, and all of our clientele work together. Tom Ryan and AAHomecare are leading the industry, and Medtrade Spring is where things will happen. BE THERE !!

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