Exogen ethics question

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Anonymous

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Are we to sell Exogen to patients that may never pay for it through Medicare? What about having drs sign office notes that we re-write for them with the correct wording in order to have an order go through? My manager oks this as do other reps in my district so we hit our quota. Is this normal practice???
 












In this economy its hard to get any patient to pay a copay let alone Medicare. This goes for the competitors as well. If the Medicare patient is not treated with an Exogen, docs will opt for surgery or additional surgery costing Medicare and potentially the patient even more money. Its makes zero business sense for Medicare and us as the taxpayer to dish out for surgery when they can get a less costly alternative (Exogen).
As far as notes, if its clarification then legit. Some docs use their own verbs while Medicare has their own keywords but in the end if its the same shit its the same shit.
 






Help the docs out by helping their office get the medical policy for the state they are in for Medicare. Get docs to use the same language and FOLLOW THE POLICY...and then fight if you dont get it covered. There are several steps a Doc or company can do to get adjudicated.
 






It is OK for a doc to retype notations or write in Insurance verbal requirement for coverage?
As long as he signs off on it, it should not be a problem. At least that is what I have been told. It is a PROBLEM if you do not have him/her sign underneath required verbage for the same diagnosis.

Face it. Surgeons do not like the word, "non-union" and prefer "delayed union" which is unacceptable by insurance companies even if it is over 90 day old fracture. It is frustrating because it ends up costing the system more money in clinic time, phone calls, etc to get the Insurance required verbage for the diagnosis.

a delayed union over 90 days should automatically be considered a non-union by insurance companies.
 






Anonymous said:
It is OK for a doc to retype notations or write in Insurance verbal requirement for coverage?
As long as he signs off on it, it should not be a problem. At least that is what I have been told. It is a PROBLEM if you do not have him/her sign underneath required verbage for the same diagnosis.

Face it. Surgeons do not like the word, "non-union" and prefer "delayed union" which is unacceptable by insurance companies even if it is over 90 day old fracture. It is frustrating because it ends up costing the system more money in clinic time, phone calls, etc to get the Insurance required verbage for the diagnosis.

a delayed union over 90 days should automatically be considered a non-union by insurance companies.
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You guys are walking a fine line, just wait until the FBI shows up on your door step with a laundry list of why they consider the things you are doing are wrong. This part of the business is dirty and will be dealt with soon...
 






You mean to say that if a fx is over 90 days old and the Doc initially writes "delayed union" that we can't explain the Medicare policy to him so he can change it to "non-union".

I am not talking about changing or altering the office notes, here. I've never played that game. However, it seems like a physician can go back and change it. Or is that illegal for him to do?

Delayed union and non-union over 90 days are virtually the same. I wish Medicare would accept the terminology "delayed union" if the date of injury was over 90 days ago. Very frustrating.
 






Anonymous said:
You mean to say that if a fx is over 90 days old and the Doc initially writes "delayed union" that we can't explain the Medicare policy to him so he can change it to "non-union".

I am not talking about changing or altering the office notes, here. I've never played that game. However, it seems like a physician can go back and change it. Or is that illegal for him to do?

Delayed union and non-union over 90 days are virtually the same. I wish Medicare would accept the terminology "delayed union" if the date of injury was over 90 days ago. Very frustrating.
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There is no doubt there are illeagel things going on when it comes to Exogen but I blame upper management and the stress they put on us to hit quota. In one conversation they say to not do these things but then that say to talk to your peers to see what they are doing. My peers say to type out the notes with correct wording and have dr sign or just forge their name. My own manager as said "do what ever I need to get it approved".
 






That's pretty bad. I have always hit my quota without resorting to such tactics. Everyone from the VP to compliance has trained you on this. If a manager or another rep is telling you to write out the physicians clinic notes YOU really should report them to the compliance hotline.
 






I call total BS on the 2nd to last post. Anybody forging a doc's name is a total idiot. Maybe that occured a year or so ago when reps and competitors were doing stupid things. Times have changed it would put the company's Medicare license in jeopardy and rep risks feds going after him/her.
 






You people are forgetting one important point. Doctors base their diagnosis on clinical data and approved clinical states. That being said, clinically, anything less than 6 months is a delayed union. The problem occurs because the insurance industry is not on the same page with the doctors. 30 days, 45 days, 90 days, these dates can all be considered the "non-union" dates for fractures by different insurance companies.
If you have a team member relationship with the doc, he will use no clinically significant healing as his diagnosis for fractures less than the 6 month clinical non-union date.
 






























why are these units always sold to Medicare when there is rental code? Wouldn't it be proper to let patient decide if they want to purchase or rent? If the product heals in average 3 months, patients would only pay 20% of rental rather than full $700 for purchase. My docs have always questioned the documentation.
 






Anonymous said:
I call total BS on the 2nd to last post. Anybody forging a doc's name is a total idiot. Maybe that occured a year or so ago when reps and competitors were doing stupid things. Times have changed it would put the company's Medicare license in jeopardy and rep risks feds going after him/her.
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Wouldn't their license be in jeopardy if they billed Medicare for something not medically reasonable and necessary? Why don't we rent these?
 






Anonymous said:
Wouldn't their license be in jeopardy if they billed Medicare for something not medically reasonable and necessary? Why don't we rent these?
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Why don't we rent these? Because the FDA does not allow it. We (I assume you mean Exogen) do not rent our units, just like NO other bone-stim rents out their unit. Exogen is also the ONLY unit that has a life-time warranty. Every other unit on the market turns off after a certain amount of time and if they need it later or break another bone, you have to pay for another one.

The idiot who said their manager or peer told them to change notes or forge a doctor's signature...if that is actually true, I would turn him or her into the hot-line immediately. It is not worth my job or my SELF-RESPECT to stoop to such levels.

I have higher ranked tier 4 territory and have NEVER had to stoop to those levels to make quota.
 






Anonymous said:
Why don't we rent these? Because the FDA does not allow it. We (I assume you mean Exogen) do not rent our units, just like NO other bone-stim rents out their unit. Exogen is also the ONLY unit that has a life-time warranty. Every other unit on the market turns off after a certain amount of time and if they need it later or break another bone, you have to pay for another one.

The idiot who said their manager or peer told them to change notes or forge a doctor's signature...if that is actually true, I would turn him or her into the hot-line immediately. It is not worth my job or my SELF-RESPECT to stoop to such levels.

I have higher ranked tier 4 territory and have NEVER had to stoop to those levels to make quota.
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What do you mean FDA does not allow you to rent? Is that what corporate told you? You can call it single patient use, (not an FDA designation,) and hide behind a class three device, but does that mean you can bill for ten months usage every time to Medicare even though it is not medically necessary? Supplier standard #5 says you must offer rental to patient.
 






Anonymous said:
What do you mean FDA does not allow you to rent? Is that what corporate told you? You can call it single patient use, (not an FDA designation,) and hide behind a class three device, but does that mean you can bill for ten months usage every time to Medicare even though it is not medically necessary? Supplier standard #5 says you must offer rental to patient.
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Gosh, I sure hope you are taking the time to go to every other company board who makes a bone stimulator and posting the same thing on theirs since NOBODY rents out their units.
 






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