Re: Orthotic 5 Year Rule
Bruce Russell
Description
Collection
Title:
Re: Orthotic 5 Year Rule
Creator:
Bruce Russell
Date:
11/22/2004
Text:
List, The overwelming consensus from practitioner experience and
corroborated by the coding committee was if you could demonstrate 1)
Functional level change 2) Irreparable damage 3) Lost or stolen that it was
advisable to have the client return to his doctor to document the existing
need for a replacement orthosis, and why.
Also submit a photo of the damaged orthosis and an explanation of the
irrepairable nature, with the claim(some suggested a paper claim). Also, be
patient and ready to appeal, but it should eventually get paid. One
practitioner expressed the need for a polaroid picture otherwise a digital
picture was the most widely used format. Also it may be of benefit to have a
signed form from the patient that the crack compromised the effectiveness
and /or safety of the orthosis. Thank you to all who replied. Bruce
Russell CO
-----Original Message-----
From: Bruce Russell [mailto:<Email Address Redacted>]
Sent: Wednesday, November 17, 2004 2:06 PM
To: <Email Address Redacted>
Subject: Orthotic 5 Year Rule
list,
I recently had a Medicare client return to our office with an AFO with an
unrepairable crack in the medial wall area. The orthosis is 3 years old.
I am a bit foggy on how the 5 year rule is interpreted regarding lost or
broken orthoses. Input would be appreciated on personal experiences of this
nature. I called Patrick Kelly but he is no longer employed.
Of course, patient under no circumstances, wants to be responsible for any
portion of the replacement orthosis and I guess will us a wheelchair for the
next 2 years when the crack finally breaks completely.
Bruce Russell CO
corroborated by the coding committee was if you could demonstrate 1)
Functional level change 2) Irreparable damage 3) Lost or stolen that it was
advisable to have the client return to his doctor to document the existing
need for a replacement orthosis, and why.
Also submit a photo of the damaged orthosis and an explanation of the
irrepairable nature, with the claim(some suggested a paper claim). Also, be
patient and ready to appeal, but it should eventually get paid. One
practitioner expressed the need for a polaroid picture otherwise a digital
picture was the most widely used format. Also it may be of benefit to have a
signed form from the patient that the crack compromised the effectiveness
and /or safety of the orthosis. Thank you to all who replied. Bruce
Russell CO
-----Original Message-----
From: Bruce Russell [mailto:<Email Address Redacted>]
Sent: Wednesday, November 17, 2004 2:06 PM
To: <Email Address Redacted>
Subject: Orthotic 5 Year Rule
list,
I recently had a Medicare client return to our office with an AFO with an
unrepairable crack in the medial wall area. The orthosis is 3 years old.
I am a bit foggy on how the 5 year rule is interpreted regarding lost or
broken orthoses. Input would be appreciated on personal experiences of this
nature. I called Patrick Kelly but he is no longer employed.
Of course, patient under no circumstances, wants to be responsible for any
portion of the replacement orthosis and I guess will us a wheelchair for the
next 2 years when the crack finally breaks completely.
Bruce Russell CO
Citation
Bruce Russell, “Re: Orthotic 5 Year Rule,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/223932.
