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Surprise! It’s A Sternly-Worded Letter!

Posted by J. Paul Spencer, CPC, CPC-H in Industry Updates

Another birthday weekend is upon me.

This coming Sunday will mark yet another anniversary of my birth. Coming up on 46, for me birthdays are no longer a celebration of my birth, but rather another mile marker on the (hopefully long) highway leading to my cremation. This is a somewhat dark way of looking at it, but as one of my living musical heroes, Robyn Hitchcock, so eloquently put it, “God finds you naked and he leaves you dying / What happens in between is up to you”.

As I get older, I find that I am making less and less time for politics in my life. There are many reasons for this, but the biggest reason is simply that every politician that I come across on the state and national stage lacks imagination. Just once, I would like to turn on C-SPAN during a Special Orders session in the House of Representatives and see a member of Congress painting a seascape, singing a new song that they’ve written or doing an interpretive dance in honor of the planet Jupiter. It would assure me that at least someone with their hands on the levers of power had the ability to think outside of the box.

In the absence of my grand vision, we are left with the oft-repeated habits of the Beltway Set; grandstanding for the cameras, filling their pockets with lobbying dollars and (my personal favorite in terms of absurdity) taking advantage of Congressional free mail to fill people’s mail boxes with letters that combine the worst of the two previous activities just listed. So much for elected leaders representing “public servants” or the “best of the best”.

If it’s another week in Washington, then someone must have sent a sternly-worded letter, and this week’s is a doozy.

Anyone who reads my missives in this space knows that I have a dim view of government audits, mainly because they are shifting the blame for abuse in the system to the wrong people, namely well-meaning hospitals and physicians who have a hard time understanding federal rules of documentation and reimbursement. We all know who the thieves are when it comes to healthcare delivery, and pelting hospitals with thousands of requests for documentation per year rarely smokes these rats out of their lairs. Claims are paid badly by MACs and subsequently reviewed poorly by RACs based on complexity built into the system by CMS. Shifting the administrative burden of such a system on providers is short-sighted and does nothing to improve the care being administered.

With all of that being said, you would think that I would be in favor of this week’s sternly-worded letter from a subcommittee of the House Ways and Means Committee to Marilyn Tavenner, the Acting Administrator of CMS. After a short preamble, the letter asks for every statement of work, performance report, case referral and contractor fee paid relating to Medicare and Medicaid program integrity efforts for every contractor involved in such activities.

You should all know by now that I’ll sprint to the front of the opinion line to talk about government audits, and I have always been a fan of full disclosure. As it applies to the Recovery Auditor Program, every quarterly report that has been issued by CMS on RAC performance is either a collection of half-truths or (in the case of the first provider accuracy scores issues by the RAC Validation Contractor) bald-faced lies. I am encouraged that CMS will be called onto the carpet regarding RAC appeal rates, as any provider that has been affected by RAC audits can tell you that a look at that aspect of the program is well overdue.

With all of that being said, it helps to consider the source of the letter to CMS. Charles Boustany, the Louisiana Congressman who chairs the oversight committee has quite the revealing report when it comes to an analysis of his biggest campaign donors. The list includes Blue Cross and Blue Shield and an organization known as the LHC Group, a nationwide provider of home health, hospice and long-term acute care services. That list of LHC’s services looks a lot like the list of the types of providers often caught in the HEAT team net. In all, Congressman Boustany has taken in over $350,000 in campaign contributions from entities involved in health care, including nearly $170,000 from various factions of the insurance industry.

Whenever a legislative opponent mugs for the camera, they do so hoping for a knowledge vacuum by the viewer. This latest in a string of sternly-worded letters that bounce back and forth within the Beltway is part of the never-ending gamesmanship that has led to the system we currently have in place. If I believed that anyone in Washington, DC cared for my opinion, I would issue my own correspondence to those in power. I can guarantee that there would be just enough in every letter to anger everyone on both sides. I can also promise you that unlike this blog, it would be unexpurgated.

I am happy with the long-overdue demands made in this letter, but I simply know better than to trust this particular messenger. It takes no imagination whatsoever to take action simply because someone pays you to do so. Sometimes, you have to do it because no one else will and it is the right thing to do. By this standard, the letter is a failure.

So if you want an uncensored and uncompensated opinion, and you’re not doing anything tomorrow night, come out and celebrate my birthday at 7:30 and I’ll be happy to impart some wisdom, but take this latest sternly-worded letter with a grain of salt until we see a response from CMS.

4 Responses to “Surprise! It’s A Sternly-Worded Letter!”

  1. Joni Baker says:

    GO Paul!! And Happy Birthday. I once fondly knew a physician who routinely pummelled the state PRO with his words of wisdom about the vagaries of Medicare rules and regulations and his feelings about them. I cheered him on as well!

  2. [...] Click here to visit the original article. Tagged with: Birthdays • Blue Cross Blue Shield • C-SPAN • Charles Boustany • CMS • HEAT • House of Representatives • House Ways and Means Committee • Industry Updates • Jupiter • LHC Group • Louisiana • MAC • Marilyn Tavenner • rac • RAC / Recovery Audit Contractors • rac audit • RAC Validation Contractor • recovery audit contractor • Robyn Hitchcock • Special Orders Speech • Washington D. C.  If you enjoyed this article, please consider sharing it! [...]

  3. [...] the provider community is overdue. Yet I would caution the reader, as I did with another such open letter issued last week, to consider the source of the request and the backdrop under which it occurs. [...]

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