Reporter's notebook: Sylvia Toscano has a dream


Sylvia Toscano, the owner of Professional Medical Administrators, has a dream that many of the industry’s audit problems could be solved by a template—not just for power mobility devices, but for all home medical equipment—incorporated into the electronic health record (EHR) that physicians are using in growing numbers.

“The only way we’re going to be successful as an industry is to figure out a way for the physicians to be prompted by a template that gives them the questions that used to be on CMNs before they were eliminated,” she said. “This would eliminate the back and forth—you didn’t do this, you didn’t do that.”

The need for a template for HME has gone from a nicety to a necessity with audits becoming more and more aggressive and destructive, Toscano said.

The latest trend she’s seeing: Less success at the administrative law judge (ALJ) level of the appeals process because judges won’t always accept information from other clinical sources, like physical therapists, as part of the medical record.

“It used to be that we had a 90% success rate at the ALJ because the judges used their clinical judgment,” she said. “They would look at the condition and the record and take everything into consideration based on the preponderance of evidence. Now they expect the actual physician’s or prescriber’s notes and record to contain information supportive of the LCD or NCD. That’s not what’s typically done.”

Toscano would like to see an industry group, coalition or organization try to open discussions with CMS and approved EHR vendors about adding a template for HME and having those vendors sell it as part of their systems.

“There are 20 such vendors, so it wouldn’t be unmanageable,” she said.

Who’s with her?



Someone may need to review the history of the industry. That was the original CMN in the industry. It was a "template". All the ordering Physician needed to do was check off the item ordered on one side and answer yes or no to the apprIopriate questions on the opposite side pertaining to the item ordered. The biggest problem with it was while Congress ordered it's use they didn't bind the Physician to it's validity. NO WAY will you ever convince CMS and/or
Congress to go backwards. You may want to talk with Providers that have been around for 20 or more years. Unfortunately, I am sorry to say, your dream will probably remain just a dream since CMS was already down this road.

As for your ALJ's, CMS is using CMS's own groomed Judges completely versed in ALL needed information. They stopped using the Social Security Judges with the enactment of MMA.