ILLEGAL OR NOT
Description
Collection
Title:
ILLEGAL OR NOT
Text:
We have O & P licensure in the state of Florida and I recently had a
disturbing conversation with a parent about a physical therapist casting for an AFO.
Cascade DAFO company billed the insurance company with L1960 as the base code.
When I called the therapist, she stated I am not making or billing for the
brace I only cast and fit these braces She also stated that she does this
during therapy sessions. DOUBLE BILLING? Evaluating, Casting, Fitting and a 3
month follow-up period is included in all L codes. I believe this therapy
practice to be double billing and violating the licensure law enforced by the
Florida dept. of health.
When I spoke to Cascade Dafo, They informed me that they use a special
modifier to these L codes stating their fee is excluding fitting and adjustments
and also send a letter stating this with the HCFA bill. I asked the Cascade
Dafo representative what this special modifier is and where I can find info on
it. Their response was that they did a lot research and that I should do the
same. If the insurance commission and the department of insurance has OK'd a
special modifier it would be public knowledge. I have never heard of these
modifiers. Since when can L codes be stripped down to not include fitting and
follow up adjustments? Can you imagine how much these insurence companies are
getting ripped off when P. T. charges for their time for casting, fitting and
adjusting braces.
This particular patient was sent to me after the brace the P. T. casted,
Cascade made and P. T. fit caused the patient to walk worse than prior to the
brace. Patient needed an adjustment to an old brace and the P. T. told the h
usband to trim the AFO with scissors. Ouch! What a lawyer could do with this
case.
1. Not licensed O & P professional
2. Billing? All parties involved can be held liable.
Is Cascade Dafo knowingly helping P.T.'s do what I understand to be ILLEGAL??
Oh, The P. T. also stated that Cascade Dafo will not bill for medicaid
patients. I wonder Why?????
Jeffrey Price, CPO
disturbing conversation with a parent about a physical therapist casting for an AFO.
Cascade DAFO company billed the insurance company with L1960 as the base code.
When I called the therapist, she stated I am not making or billing for the
brace I only cast and fit these braces She also stated that she does this
during therapy sessions. DOUBLE BILLING? Evaluating, Casting, Fitting and a 3
month follow-up period is included in all L codes. I believe this therapy
practice to be double billing and violating the licensure law enforced by the
Florida dept. of health.
When I spoke to Cascade Dafo, They informed me that they use a special
modifier to these L codes stating their fee is excluding fitting and adjustments
and also send a letter stating this with the HCFA bill. I asked the Cascade
Dafo representative what this special modifier is and where I can find info on
it. Their response was that they did a lot research and that I should do the
same. If the insurance commission and the department of insurance has OK'd a
special modifier it would be public knowledge. I have never heard of these
modifiers. Since when can L codes be stripped down to not include fitting and
follow up adjustments? Can you imagine how much these insurence companies are
getting ripped off when P. T. charges for their time for casting, fitting and
adjusting braces.
This particular patient was sent to me after the brace the P. T. casted,
Cascade made and P. T. fit caused the patient to walk worse than prior to the
brace. Patient needed an adjustment to an old brace and the P. T. told the h
usband to trim the AFO with scissors. Ouch! What a lawyer could do with this
case.
1. Not licensed O & P professional
2. Billing? All parties involved can be held liable.
Is Cascade Dafo knowingly helping P.T.'s do what I understand to be ILLEGAL??
Oh, The P. T. also stated that Cascade Dafo will not bill for medicaid
patients. I wonder Why?????
Jeffrey Price, CPO
Citation
“ILLEGAL OR NOT,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/221241.
