HomeMy WebLinkAbout20030533.tiff February 13,2003
To: Commissioner Robert Masden
PO Box 758 [ ? j L ". Iv. n
915 10t Street
Greeley, CO 80632
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From: Troy Chase and Dirk Smith
Owners and operators of MedVan
2508 50th Avenue
Greeley, CO 80634
Phone: 970-330-3640
Fax: 970-339-0081
Dear Commissioner Robert Masden:
Subject Two-Week Prior Authorizations for Dialysis Clients
Since October first, 2002, when Weld County Transportation Services became the broker for Medicaid transportation in
Weld County, several changes and mandates were implemented for Prior Authorizations which have proved to be a
challenge for Medicaid clients to adhere to and understand. The most problematic for MedVan, clients, dialysis staff and
caregivers/family members is the two-week approval for dialysis patients' transports. In order to help clients and/or
caregivers adjust to the requirement to call every two weeks, MedVan has been calling all dialysis clients or their
caregivers upon the expiration of their authorization to remind them to place the call to Weld County Transportation
Services for renewal. Given the time this requires it has become cost prohibitive for MedVan staff to continue to assist
clients with this function. Therefore, as of March 1, 2003, MedVan will no longer call clients and/or caregivers to remind
them to call Weld County Transportation Services for their renewal. In addition, in order to stay compliant, MedVan will not
transport clients without the authorization from Weld County Transportation Services.
We are sending this letter to you, all dialysis clients, Weld County Transportation Services and the health care
professionals involved because we are gravely concerned about the possibility of clients missing their regularly scheduled
dialysis treatments which could result in hospital confinement, serious medical conditions and loss of live. In order for
MedVan to provide transportation clients must obtain prior approval from Weld County Transportation Services and then
Weld County Transportation Services then notifies MedVan of the approval. In a perfect world all clients and/or caregivers
would perform this task every two weeks on their own. But, due to various reasons such as diminished mental capacity,
unaccountable family members, language barriers and declining health of clients the expectation for all clients to
remember to call Weld County Transportation Services every two weeks is highly unrealistic. Even clients in skilled
nursing facilities are at risk of the telephone calls not being made every two weeks. Although dedicated responsible health
care workers are caring for them, staff tum-over and miscommunication can hinder the telephone calls being placed to
Weld County Transportation Services every two weeks. The result in this break down will be missed dialysis treatments,
which can have disastrous consequences for the client.
Obviously, the most critical aspect of the two-week authorization mandate is the potential for negative medical outcomes
for dialysis clients. However approving transports for dialysis clients for only two weeks at a time, influences the schedule
of MedVan employees and Willow Station Dialysis. Given the fact that MedVan is a small company with only five full time
divers in Greeley, employee requests for time off depends largely on our schedule. To not answer a driver's request until
two weeks prior is unfair to the driver. Furthermore, the increased chance for clients to miss a dialysis treatment if clients
are no longer reminded to make the calls for authorization will impact the staffing and schedule at Willow Station Dialysis.
In addition to the previously stated issues, the two-week approval mandate creates what seems to be a burdensome
system for the staff at Weld County Transportation Services. The telephone call volume is immense as well as the
paperwork. Citing the drawbacks stated above, the industry standard for other brokers in Colorado range from one month
approval in Logan County to six month approval in Arapahoe County.
All of the above stated concerns can be addressed and alleviated by extending the approval for dialysis clients only, to a
three-month period. If this could be accomplished, MedVan staff will be happy to continue to assist clients with this
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process by to placing reminder calls to clients and/or caregivers the week before the approval expire. This would
decrease the telephone call volume to Weld County Transportation Services, enable MedVan to staff, schedule
accordingly, and decrease the risk of MedVan transporting without prior approval. Nevertheless, most importantly,
diminish the opportunity for clients to miss regularly scheduled dialysis treatments. This will decrease the chance of clients
suffering life threatening complications that could result in lengthy hospital confinement or worse.
When this recommendation was brought to Patsy Drewer, she expressed concern regarding fraudulent billing. She felt
extending the approval for more than two weeks would prove to be difficult for Weld County Transportation Services to
track the legitimacy of the transports. However, the three-month approval would require the same documentation as the
two-week and would only be afforded to dialysis clients. Currently the system requires the approval match the date of
transport, pick up address, destination address, mileage and a client or caregiver signature for each trip. If a client
requires a transport on a date other than what the approval states, a separate approval from Weld County Transportation
Services is required. Therefore, the risk for fraud or inappropriate trip is the same for a two-week approval as it is for a
three-month approval. All of the above requirements would still have to be satisfied in order to bill for a transport.
Our goal is to continue to service the disenfranchised members of our community in a responsible manner in order for
them to access medical services that sustain life. By understanding the importance of attending regularly scheduled
treatments and combining all of our efforts, we hope to avoid the need for clients to seek more intensive and emergent
care. Your careful and prompt consideration of this proposal would be greatly appreciated. If you or any of the people that
receive this letter would like to meet to discuss ways that we can improve our service, communication, or enhance the
process currently in place,we would welcome an open dialogue. Thank you for taking the time to read this letter.
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Sincerely, �C /�`
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Troy Chase and Dirk Smith
Owners
MedVan
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cc: Patsy Drewer
Waft Speckman
Dr. Rademacher
Willow Station Dialysis
Discharge Planning at N.C.M.C.
Dan Gauger(Life Care Administrator)
Jim Cuhran(Centennial Health Care Administrator)
Kathy Mekelburg(Fair Acres Manor Administrator)
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