AOPA Letter to Tavenner and Sebelius Further Challenges “Dear Physician” Letter

AOPA’s counsel on CMS matters, Tom Mills of the law firm Winston and Strawn, has issued a second letter to HHS Secretary Sebelius and CMS Acting Administrator Tavenner again seeking withdrawal of the “Dear Physician Letter” which unleashed the horrendous increase in RAC and other audits as well as burdensome prepayment reviews.  All of these actions by CMS contractors have delayed or prevented timely patient services in O&P and disrupted cash flow so completely that many O&P patient care facilities have closed their doors after decades of service or downsized staff dramatically.

In addition to requesting withdrawal of the August 2011 “Dear Physician Letter,” Mr. Mills requested further CMS correction “by instructing CMS contractors to treat the prosthetists notes as part of the medical record, and by insisting that CMS contractors explain in detail the basis for any disallowance of claims for prosthetic devices.”

AOPA continues to maintain the “Dear Physician” letter was “improperly issued” without following the necessary procedures allowing public comment.  The letter also points out that “CMS’ own Manual recognizes that prosthetists records are entitled to the same deference as physician records.”

It goes on to say that “CMS’ justification for now ignoring its own Manual and refusing to treat prosthetists’ notes as part of the medical record is that prosthetists may have a ‘vested financial interest in the outcome of the claim decision.’  This justification is ironic, given the vested financial interest CMS contractors have in disallowing the claims they are hired to review.  As AOPA has pointed out, there are scores of situations in which physicians make judgments that arguably could be affected by self-interest, yet CMS does not challenge those judgments.”

Click here for the April 15, 2013 letter to HHS Secretary Sebelius and Administrator Tavenner and here for the December 14, 2012 letter to Marilyn Tavenner.

This second Attorney Mills letter references letters AOPA has also sent to CMS official, George G. Mill, Jr., Director, Provider Compliance Group, which manages the CMS contract auditors.  Read AOPA’s letters to George Mills and the responses.