Ronda’s Rant: When “Protecting” the Medicare Trust Fund Hurts Beneficiaries

Posted on in Billing/Reimbursement, HME Government Issues

“Protecting the Medicare Trust Fund” are words I hear or read on a regular basis. The DME medical community and all other Medicare providers are obligated to “protect the Medicare Trust Fund.” All trust funds require checks and balances to prevent fraud and abuse. But, there has to be a balance: When do the protection efforts actually hurt the recipients that the fund was intended for?

An example lies within the PAP policy. If the patient is not compliant within 90 days of the initial date of service, then the patient is required to start all over by initiating another visit with the physician and undergoing a repeat sleep study. Does this protocol make the most financial sense in an effort to protect the Medicare Trust Fund, and is the ultimate outcome of treating the patient’s condition and having a compliant patient been achieved? I know what my answer is!

Other examples are those HCPCS codes that fall under the ACA 6407 Face-to-Face Ruling that require a date stamp of receipt by the supplier prior to delivery. The ruling states that a supplier must date stamp when they received the WOPD to show Medicare that the order was received prior to delivery.  Confusion often comes into play with CMS if the date stamp and the fax date do not match or if the fax date is missed when the document is scanned. There have been many denials on the WOPD because of the date stamp of receipt was missing or not clear to the reviewer. As a result, the supplier doesn’t get paid, and the patient would have to go to another supplier. As mentioned before, the result is an untreated patient, an unpaid supplier and money wasted as the desired outcome was not achieved.

No system is perfect in any industry. Whether you are dealing with health care products or hair care products, there will always be some bad people doing some bad things. As a result, there will always be government rules and regulations to monitor and oversee. The issue is don’t let the rules override the desired outcomes, because when that happens, everybody loses. 

As Ben Franklin said, “We must indeed all hang together, or most assuredly we shall all hang separately.” With our efforts at VGM and the support of you, our membership, we’ll all continue to work together to get the focus of our businesses back to providing equipment and services to the Medicare beneficiaries and less on audits and date stamps.