Summary of Responses re OTS fitting
David Hendricks
Description
Collection
Title:
Summary of Responses re OTS fitting
Creator:
David Hendricks
Date:
3/31/2018
Text:
Dear Colleagues,
On March 19, 2018 I posted a double question, which I'll summarize here: 1. Assuming an O&P licensure state, can an unlicensed and uncredentialled provider legally fit a back or knee brace on a patient, so long as they bill using the OTS code? 2. If that same person merely hands the brace to the patient and talks them through donning it, is that a violation of licensure law?
I received a lot of good responses. Here's a summary, identities omitted:
||
Non licensed in a licensure state is the same as non-credentialed. If they are credentialed but not licensed in a licensure state, it is still unlicensed activity and any accreditation organization would prohibit care by unlicensed persons.
||
I have only worked in one licensure state (WA). The company I work for has both certified fitters and clinicians. With that being said the state has a listing of items that can only be fit by a practitioner - this was listed on the Medicaid site along with the breakdown of which items were covered and which items need prior auth.
||
I live in a licensure state (Tennessee) and there is a company here in town that sells components to surgeons for spinal surgeries, and will fit the back brace prior to surgery as well. They are neither an orthotist (by schooling or training of any kind), or licensed, yet they bill the braces as OTS and have fit patients with said braces both in an office and at their homes.
Anyway, I feel that our field hurt themselves by making it such that O&P can be fit by anyone under a doctor or therapist's supervision, because that is what opened this door to being able to fit OTS items. I think the law is such that as long as you fit OTS items and do not call yourself an orthotist (CO, fitter, COA), then you can fit without a license. I hate it, but I feel that is what happened.
Now let's be honest, we have also made it extremely easy for anyone to fit orthotics by making everything so easy to adjust and fit, with most things coming off the shelf and only needing Velcro strap adjustments. In that, we made our lives easier to fit more items with speed and ease both in and out of the office, but that also is putting out field at risk because Medicare does not see the need for a credentialed person's skill to fit most braces.
||
Great topic, one that just chaps my hind quarters.
Answer to question 2 should be legal if u follow the letter of the law as your human drone did not touch the consumer.
This brings me to the most irritating part of the equation. I am so appalled at the ineptness of our Board for not pursuing this situation.
Many years ago all licensed P and O personnel received a letter from the FL Board of O and P stating that if we knew of non-licensed individuals administering a prosthesis or orthosis and did not report it to the board and was then discovered, we too would be held responsible and have to pay the same fine of $5000.00 per incident.
Well, I gave them a call shortly after the letter arrived knowing several individuals partaking in our profession without license but did not give any names. Their response to me was We only regulate licensed individuals. I paused waiting for the but part of the answer. There had to be more to it.
But that is all I received. I was dumbfounded. My next question was why then did we receive a threatening letter that meant absolutely nothing but time, paper, and postage that WE payed for with our dues. She then came clean and admitted that it is was presently not in the budget and had no idea of when it might be budgeted.
I have since made several calls to see if any changes and can't get a straight answer from anyone in Tallahassee. All this law has created is worthless monies spent. They do nothing for us, period
And here endith the rant.
||
It is unlicensed activity in FL and needs to be reported.
||
As a board member of the Kentucky Board of Orthotic Prosthetic Pedorthic, these questions do come up frequently. My reply will be based on Kentucky State Statue for O&P. Our statue does not distinguish between an OTS or a custom fitted device. The questions need to be asked, who receives the RX? In your case an LSO. Who interprets the RX, who determines what kind of LSO should be used. Who measures for the device, selects the size, dons the device, instructs the patient. If any of these events are performed by a non-licensed individual, then that person is in violation of our Statue. In our board meetings, our determination is: If a patient walks in facility goes to a display shelf, selects his own device and pays the cashier, without any assistance, the cashier is NOT in violation. In reality, we know your scenario is prevalent, but the board can only take action when there is a formal complaint. If you believe someone is in violation of Florida's statue, then file a complaint and the board will investigate.
||
If the person delivering the orthosis made adjustments to the orthosis, then that individual has to be licensed. This brace is no longer considered OTS. For example: a cam-walker needs to be delivered and the aluminum uprights were shaped but not to the individuals LE. This is still custom fitted and not OTS. The individual has to be licensed because the brace was altered. This puts a higher degree of liability for the individual or company even if the orthosis was not donned on the patient. Hope this helps.
||
As long as the employee doesn't call themselves an orthotist and is licensed through another entity such as RN, MD, PTA, even a medical assistant or nurse aid could fit an orthosis as long as it is billed under the care of a Medicare approved license/group.
This is why licensure, although noble in its efforts does nothing to protect the orthotist/prosthetist in the long run. It only polices fellow credentialed persons who may have a BOC or ABC certificate but not meet current license requirements.
||
The only way it legally avoids the fitting/licensure/standards requirements is if the delivery person is directly (on site) supervised by the licensed, credentialed person AND they didn't touch the patient. To which I say, if they're sending 2 people out to do the work of 1, there's a lovely bridge I could sell ya...
||
I believe you're making several erroneous assumptions.
First, CMS is a payor having not the slightest inclination to worry about the quality of patient care. They require certification (licensure in license states) only as an attempt to reduce fraud and curb wasteful spending. State law trumps federal law when it comes to treating patients. CMS is supposed to (even though in reality it doesn't follow its own rules) pay only licensed individuals in states having licensure. This reality is further confused by CMS's method of paying a company and not licensed individuals. Example, ABC company is headed by an LPO having several LO's, LP's, LOF's and non-licensed staff. When any claim is submitted to CMS, no matter who treated the patient, it is submitted and paid under the LPO's name and license. Under state law the treatment of the patient may or not been legal, but since CMS sees only the company name and legally licensed representative it pays the claim.
Second, you confuse the argument by introducing the terms certified and credentialed into the discussion as to licensed states. In licensed states whether or not a person is credentialed or certified is immaterial, only if the person is licensed and working within their scope of practice.
Finally, in licensed states the only overriding concern is if the person treating the patient is licensed and working within their scope of practice. How the company obtains payment is immaterial, as is the question of OTS vs custom fitted. The only relevant question is if the person is appropriately licensed.
||
Thanks to all for good, informative responses!
David Hendricks
David Hendricks, CPO
President
Blue Diamond Orthopedic
6439 Milner Blvd
Suite 4
Orlando, FL 32809
<Email Address Redacted> <mailto:<Email Address Redacted>>
407-613-2001 Phone
407-613-2010 Fax
On March 19, 2018 I posted a double question, which I'll summarize here: 1. Assuming an O&P licensure state, can an unlicensed and uncredentialled provider legally fit a back or knee brace on a patient, so long as they bill using the OTS code? 2. If that same person merely hands the brace to the patient and talks them through donning it, is that a violation of licensure law?
I received a lot of good responses. Here's a summary, identities omitted:
||
Non licensed in a licensure state is the same as non-credentialed. If they are credentialed but not licensed in a licensure state, it is still unlicensed activity and any accreditation organization would prohibit care by unlicensed persons.
||
I have only worked in one licensure state (WA). The company I work for has both certified fitters and clinicians. With that being said the state has a listing of items that can only be fit by a practitioner - this was listed on the Medicaid site along with the breakdown of which items were covered and which items need prior auth.
||
I live in a licensure state (Tennessee) and there is a company here in town that sells components to surgeons for spinal surgeries, and will fit the back brace prior to surgery as well. They are neither an orthotist (by schooling or training of any kind), or licensed, yet they bill the braces as OTS and have fit patients with said braces both in an office and at their homes.
Anyway, I feel that our field hurt themselves by making it such that O&P can be fit by anyone under a doctor or therapist's supervision, because that is what opened this door to being able to fit OTS items. I think the law is such that as long as you fit OTS items and do not call yourself an orthotist (CO, fitter, COA), then you can fit without a license. I hate it, but I feel that is what happened.
Now let's be honest, we have also made it extremely easy for anyone to fit orthotics by making everything so easy to adjust and fit, with most things coming off the shelf and only needing Velcro strap adjustments. In that, we made our lives easier to fit more items with speed and ease both in and out of the office, but that also is putting out field at risk because Medicare does not see the need for a credentialed person's skill to fit most braces.
||
Great topic, one that just chaps my hind quarters.
Answer to question 2 should be legal if u follow the letter of the law as your human drone did not touch the consumer.
This brings me to the most irritating part of the equation. I am so appalled at the ineptness of our Board for not pursuing this situation.
Many years ago all licensed P and O personnel received a letter from the FL Board of O and P stating that if we knew of non-licensed individuals administering a prosthesis or orthosis and did not report it to the board and was then discovered, we too would be held responsible and have to pay the same fine of $5000.00 per incident.
Well, I gave them a call shortly after the letter arrived knowing several individuals partaking in our profession without license but did not give any names. Their response to me was We only regulate licensed individuals. I paused waiting for the but part of the answer. There had to be more to it.
But that is all I received. I was dumbfounded. My next question was why then did we receive a threatening letter that meant absolutely nothing but time, paper, and postage that WE payed for with our dues. She then came clean and admitted that it is was presently not in the budget and had no idea of when it might be budgeted.
I have since made several calls to see if any changes and can't get a straight answer from anyone in Tallahassee. All this law has created is worthless monies spent. They do nothing for us, period
And here endith the rant.
||
It is unlicensed activity in FL and needs to be reported.
||
As a board member of the Kentucky Board of Orthotic Prosthetic Pedorthic, these questions do come up frequently. My reply will be based on Kentucky State Statue for O&P. Our statue does not distinguish between an OTS or a custom fitted device. The questions need to be asked, who receives the RX? In your case an LSO. Who interprets the RX, who determines what kind of LSO should be used. Who measures for the device, selects the size, dons the device, instructs the patient. If any of these events are performed by a non-licensed individual, then that person is in violation of our Statue. In our board meetings, our determination is: If a patient walks in facility goes to a display shelf, selects his own device and pays the cashier, without any assistance, the cashier is NOT in violation. In reality, we know your scenario is prevalent, but the board can only take action when there is a formal complaint. If you believe someone is in violation of Florida's statue, then file a complaint and the board will investigate.
||
If the person delivering the orthosis made adjustments to the orthosis, then that individual has to be licensed. This brace is no longer considered OTS. For example: a cam-walker needs to be delivered and the aluminum uprights were shaped but not to the individuals LE. This is still custom fitted and not OTS. The individual has to be licensed because the brace was altered. This puts a higher degree of liability for the individual or company even if the orthosis was not donned on the patient. Hope this helps.
||
As long as the employee doesn't call themselves an orthotist and is licensed through another entity such as RN, MD, PTA, even a medical assistant or nurse aid could fit an orthosis as long as it is billed under the care of a Medicare approved license/group.
This is why licensure, although noble in its efforts does nothing to protect the orthotist/prosthetist in the long run. It only polices fellow credentialed persons who may have a BOC or ABC certificate but not meet current license requirements.
||
The only way it legally avoids the fitting/licensure/standards requirements is if the delivery person is directly (on site) supervised by the licensed, credentialed person AND they didn't touch the patient. To which I say, if they're sending 2 people out to do the work of 1, there's a lovely bridge I could sell ya...
||
I believe you're making several erroneous assumptions.
First, CMS is a payor having not the slightest inclination to worry about the quality of patient care. They require certification (licensure in license states) only as an attempt to reduce fraud and curb wasteful spending. State law trumps federal law when it comes to treating patients. CMS is supposed to (even though in reality it doesn't follow its own rules) pay only licensed individuals in states having licensure. This reality is further confused by CMS's method of paying a company and not licensed individuals. Example, ABC company is headed by an LPO having several LO's, LP's, LOF's and non-licensed staff. When any claim is submitted to CMS, no matter who treated the patient, it is submitted and paid under the LPO's name and license. Under state law the treatment of the patient may or not been legal, but since CMS sees only the company name and legally licensed representative it pays the claim.
Second, you confuse the argument by introducing the terms certified and credentialed into the discussion as to licensed states. In licensed states whether or not a person is credentialed or certified is immaterial, only if the person is licensed and working within their scope of practice.
Finally, in licensed states the only overriding concern is if the person treating the patient is licensed and working within their scope of practice. How the company obtains payment is immaterial, as is the question of OTS vs custom fitted. The only relevant question is if the person is appropriately licensed.
||
Thanks to all for good, informative responses!
David Hendricks
David Hendricks, CPO
President
Blue Diamond Orthopedic
6439 Milner Blvd
Suite 4
Orlando, FL 32809
<Email Address Redacted> <mailto:<Email Address Redacted>>
407-613-2001 Phone
407-613-2010 Fax
Citation
David Hendricks, “Summary of Responses re OTS fitting,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/208762.
