12/15/2021    Paul Kesselman, DPM

DME Denials (William H FitzPatrick, DPM

I am sorry but Dr. FitzPatrick seems to have missed
the point. Leapfrogging to a Congressional
representative without first allowing the system to
respond will no doubt beg the question: what proof
do you have of this is a conspiracy (though I agree
it may exist) ? I have worked with those who are JD
both with and without the DPM degree. All ask the
same question prior to wanting to take this to the
next level. Prove you are right. Let us see the
evidence supporting what you say. I have had my
fill of going to meetings with DME MAC medical
directors or the RAC and sheepishly have to admit
that I will get the proof of my contentions and
then only have to respond to their inquires that
can't get them.

From my own personal practice perspective, I have
had 2 RAC audits in my practice lifetime and past
both without any issues. I know of others who have
done the same and yet I have heard from many others
who repeatedly fail. Some the documentation is
perfect some not so and many others its amazing
they got paid either via TPE or otherwise.

If you have this proof, APMA along with the DME
workgroup will take this evidence to meetings and
go to bat for you without it costing you a red
nickel. This whether you are an APMA member or not
because this effects everyone.
Again I have asked this of AOPA, PFA and other
organizations because the more organizations who
can prove this contention the stronger will be the
argument.
Going to Congress with this is certainly something
worthwhile but will meet the wrath of the DME MAC,
CERT, QIC and RAC if you first don't attempt to
work things out with them.

While representing podiatrists via APMA and the
Jurisdictional Council and at meetings with the RAC
and others have found that building relationships
to resolve problems is far better than confronting
them especially with Congressional or legal
pressures. That solution certainly should be
reserved for when other alternatives have failed.

I suggest that anyone who has proof that the RAC
has ignored their documentation to contact APMA's
Health Policy Department. This way your information
may be reviewed. If it is what I too believe is a
conspiracy by the RAC to ignore documentation, it
will be dealt with in the appropriate manner. First
by confronting the RAC medical directors and if
that does not resolve it with CMS and then with
Congress.

The RAC works as a bounty hunter and only gets paid
if you pay back the recoupment.
I also would suggest that your first appeal be back
to your DME MAC. If that proves successful (and
most do) and we have an accumulation of RAC denials
which are then overturned on appeal at the DME MAC
level that should prove damning evidence and choke
the RAC where they feel it the most. In their
pocketbook.

To sum up, I am on the side of the provider
(suppliers) and have long suspected a RAC
conspiracy to deny. But we need proof and only the
supplier and provider community can prove this.
Whether we are speaking of DME or otherwise. The
RAC has a long list of reviewed topics, as DME is
only a small area they cover. It is one thing to
suggest a conspiracy, it, it is another to prove
it.

Paul Kesselman, DPM, Oceanside, NY

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