FYI Medicare and CCSVI

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Postby HappyPoet » Wed Dec 01, 2010 9:09 am

Hi Everyone,

Megan Wilcox of Dr. Mehta's office just called me to say that Medicare is officially denying payment for anything and everything to do with CCSVI testing and treatment for pwMS. This is distressing news for everyone on Medicare, including me.

She emailed to me the official letter they received from Medicare, but I do not know how to copy it -- nothing I try works. Is there someone I can forward the email to (with the letter as an attachment) who knows how to copy/paste it into this thread?

In the meantime, I will try uploading the letter to Photobucket.com to see if I can then put the letter into this thread using the IMG (image) coding.

~Pam
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Postby Donnchadh » Wed Dec 01, 2010 9:39 am

If this indeed true, it's a change in coverage.

I'm screwed as Medicare is my only coverage.

Appreciate seeing this letter.

Donnchadh
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Postby CCSVIhusband » Wed Dec 01, 2010 9:59 am

A bunch of people on Facebook are saying that their procedures were covered as late as last week. It's all in the billing codes used.
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Postby Cece » Wed Dec 01, 2010 10:01 am

Last week and this week could be different things. Let's see that letter, HappyPoet. You can forward it to me but I can't guarantee I'll figure out how to copy it either.
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Postby CCSVIhusband » Wed Dec 01, 2010 10:09 am

I'm not allowed to bring up talk of the government's involvement, and how our healthcare (non-private healthcare I should add) in the US is going the way of Canada and England ... or I would.

:? ... just saying.
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Postby Donnchadh » Wed Dec 01, 2010 10:37 am

I typed out the key points in a post below.

Donnchadh
Last edited by Donnchadh on Wed Dec 01, 2010 12:38 pm, edited 3 times in total.
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Postby nellie » Wed Dec 01, 2010 10:40 am

Can't pull that url up.
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Postby Donnchadh » Wed Dec 01, 2010 10:44 am

Look below.


Donnchadh
Last edited by Donnchadh on Wed Dec 01, 2010 12:40 pm, edited 1 time in total.
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Postby HappyPoet » Wed Dec 01, 2010 10:45 am


Donnchadh, I get an error when I click on the link.

Cece, forwarding the email to you now. If you can't copy/paste it, perhaps you can give us your take on what it says?

In the meantime...

Megan said that Dr. Roddy of The Vascular Group, which includes Dr. Mehta, conducted the talks with Medicare, and this letter represents the final determination.

All pwMS on Medicare who want CCSVI testing and treatment may be screwed because the letter is on national letterhead signed by a medical director and cc'd to two other medical directors:

National Government Services, Inc.
PO Box 7108
Indianapolis, IN 46207
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Postby Donnchadh » Wed Dec 01, 2010 10:49 am

What it says is that Medicare will not pay for diagnositic testing or venogram treatment for "MS"


however,

what about being treated for a stenosis? and not mentioning any possible connection with "MS"?

Donnchadh
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Postby HappyPoet » Wed Dec 01, 2010 10:50 am

CCSVIhusband, could you please stop trying to instigate trouble. This is serious business. Thank you.

Edit: Thanks, CCSVIhusband.
Last edited by HappyPoet on Wed Dec 01, 2010 1:04 pm, edited 2 times in total.
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Postby HappyPoet » Wed Dec 01, 2010 11:16 am

Donnchadh wrote:What it says is that Medicare will not pay for diagnositic testing or venogram treatment for "MS"


however,

what about being treated for a stenosis? and not mentioning any possible connection with "MS"?

Donnchadh

Interesting questions, Donnchadh. But I believe Dr. Mehta could not do that because doing so at this point in time would be fraudulent. I don't know what ethics other doctors might have.

Megan said that this ruling affects me, so being "grandfathered" won't work which means that if I need another venogram should I restenose, testing and treatment won't be covered -- I cannot pay $10,000 per venography/venogram. If I had known a denial could happen in the future, I might not have pursued CCSVI testing/treatment at this time.

Intimal hyperplasia from balloon venoplasty can happen at anytime up to a year. What if an emergency arises? Will Medicare pay for emergency testing and treatment?

Anyone know?
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Postby Cece » Wed Dec 01, 2010 12:12 pm

HappyPoet, I haven't much time right now but I looked over the letter. It's legit.

You raise good points about possible emergency care or future treatment. Reminds me of what our Canadians have gone through.

I think this does remain a matter of some risk for our providers. If other docs submit under other codes, then they are running the risk of not getting reimbursed. :(

It is ok for Dr. Mehta's group to choose not to take that risk or to have wanted it spelled out from Medicare that this would be compensated. Having been denied that, it would seem this is the end of the road for Medicare patients with Dr. Mehta's group but not yet with other groups. We can wait for more shoes to drop.
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Postby Donnchadh » Wed Dec 01, 2010 12:27 pm

The original attachment was in .pdf format, which I printed out and then scanned back to my documents folder in .jpg format.

But I am having trouble uploading it to my server, so what follows is the key part:

QUOTE:

National Government Services, Inc.
P.O. Box 7108
Indianapolis, IN 46207-7108

www.NGSMedicare.com

A CMS Contracted Agent

November 18, 2010

Sean P. Roddy, MD
The Vascular Group, PLLC
The Institute for Vascular Health and Disease
43 New Scotland Avenue
MC 157
Albany, NY 12208-3412

Re: Venogram and Venoplasty for Multiple Sclerosis Patients

[major snip-deals mostly with supplied evidence for cause]

[what follows below is the determination]

It appears that diagnostic venography and venoplasty is not yet standard of care and currently remains investigational.

Therefore, these services remain Medicare non-covered and non-reimbursable, even when performed outside of a clinical trial. All diagnostic tests for the purpose of identifying MS patients with venous obstruction (e.g., ultrasound, constrast venography, etc.) as well all services related to the treatment of such obstructions (e.g., venoplasty), and all related services, are considered not reasonable or necessary, and will be denied.

I regret that my response could not have been more favorable.

Sincerely,

Paul G. Deutsch, MD
Medical Director, MAC J-13

UNQUOTE
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Postby Donnchadh » Wed Dec 01, 2010 12:33 pm

Cece wrote:HappyPoet, I haven't much time right now but I looked over the letter. It's legit.

You raise good points about possible emergency care or future treatment. Reminds me of what our Canadians have gone through.

I think this does remain a matter of some risk for our providers. If other docs submit under other codes, then they are running the risk of not getting reimbursed. :(

It is ok for Dr. Mehta's group to choose not to take that risk or to have wanted it spelled out from Medicare that this would be compensated. Having been denied that, it would seem this is the end of the road for Medicare patients with Dr. Mehta's group but not yet with other groups. We can wait for more shoes to drop.


I am afraid that this ruling will effect all future Medicare determinations, not just this particular practice.

Also, I would not be surprised if private insurance carriers use this Medicare ruling as a basis for denying claims, as it is now considered to be officially "experimental."

A severe setback for CCSVI treatment-unless you have cash to pay for treatment.

A totally depressed and bummed out, Donnchadh
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