Dynamic orthoses billing RESPONSES
Randy McFarland
Description
Collection
Title:
Dynamic orthoses billing RESPONSES
Creator:
Randy McFarland
Date:
4/21/2008
Text:
ORIGINAL POST:
I used the OPIE search engine at www.oandp.com < <URL Redacted>>
and determined that I've posted on this subject 3 and 6 years ago and
now I'm wondering what you do now when a doctor specifies a
Dynasplint. Medicare reimbursement only covers rental of these
devices, I understand. How many of you are actually renting such
devices, (like UltraFlex) or are you suggesting alternative devices that
we can provide and get reimbursed for? Let me know and I'll post the
responses back to the list.
Thanks,
Randy McFarland, CPO
Fullerton, CA
RESPONSES:
Peg Leg Krewe has a scholarship program for amputees. They are great
people doing a great thing for other people that need a little help.
<URL Redacted>
For what it is worth, we generally recommend custom fabricated UltraFlex
and have no trouble getting reimbursement for them, whether they are
AFOs, KOs, KAFOs, EWHFOs, etc.
I'd advise the Dr. to call Dynaflex to rent them or I fab with
Ultraflex. KIS(Silly). I tell the Pt. & Dr. the concentric joints may
not be covered use an ABN, and try to L2999 it to get paid. Otherwise
they would have us renting the TLSO just till the pt. doesn't need it.
END of O &P.
If the doc ok's substitution, I use Ultraflex or DeRoyal as both are
relatively cost effective. If they demand Dynasplint, I tell them that
the Dynasplint people won't work with us and they will have to contact
them directly. I also explain that I can provide a different splint
that does the same thing.
If it is Medicare covered, I usually refer them to our local Dynasplint
reps. Private insurance may pay for the Ultraflex systems. EMPI has
these systems and will sell to orthotists, but you are reimbursed on a
monthly rental basis. I tried this once, but these patients need
follow-up on a regular basis and many have difficulty getting to your
office, so look at travel costs as part of your expenses. One patient
died and I could not get the device returned from the survivors.
Dynasplint reps do a good job in my area and I get referrals from them
now and again for definitive orthoses.
I have done the Dynasplint rental thing long ago and was very
disappointed as we do not have a method for rental and the device was
marginal. I have used Ultraflex and they have very nice units and now
new joints and lock outs. I would suggest to the physician as I am
certain they have no idea which is best. They are relying on you for
insight as you already know. Its like Kleenex, TED hose etc.
I find that Dynasplint has a very effective marketing network. Often
times I get a prescription specifically ordering the Dynasplint. I will
make a call, or visit the physician ordering the orthosis and make an
effective case AGAINST the Dynasplint and tell of the advantages of the
Ultraflex System. Thus far I have never been denied. To me , clearly
the advantages greatly outweigh in favor of the Ultraflex. Thus far
this year I have used over 20 Ultraflex. I do not use the OTS---I use
the custom 100%. Reimbursement can be a problem when it comes to the
power unit but thus far I think for the power unit at least our cost has
been covered. I personally do not have any desire to enter the rental
arena, of course using only custom this would rule out rental.
One of our recent Ultraflex clients was able to walk to the lectern with
bilateral stance phase Ultraflex KAFOs and receive her PhD at Baylor. I
was sure happy for her.
I used the OPIE search engine at www.oandp.com < <URL Redacted>>
and determined that I've posted on this subject 3 and 6 years ago and
now I'm wondering what you do now when a doctor specifies a
Dynasplint. Medicare reimbursement only covers rental of these
devices, I understand. How many of you are actually renting such
devices, (like UltraFlex) or are you suggesting alternative devices that
we can provide and get reimbursed for? Let me know and I'll post the
responses back to the list.
Thanks,
Randy McFarland, CPO
Fullerton, CA
RESPONSES:
Peg Leg Krewe has a scholarship program for amputees. They are great
people doing a great thing for other people that need a little help.
<URL Redacted>
For what it is worth, we generally recommend custom fabricated UltraFlex
and have no trouble getting reimbursement for them, whether they are
AFOs, KOs, KAFOs, EWHFOs, etc.
I'd advise the Dr. to call Dynaflex to rent them or I fab with
Ultraflex. KIS(Silly). I tell the Pt. & Dr. the concentric joints may
not be covered use an ABN, and try to L2999 it to get paid. Otherwise
they would have us renting the TLSO just till the pt. doesn't need it.
END of O &P.
If the doc ok's substitution, I use Ultraflex or DeRoyal as both are
relatively cost effective. If they demand Dynasplint, I tell them that
the Dynasplint people won't work with us and they will have to contact
them directly. I also explain that I can provide a different splint
that does the same thing.
If it is Medicare covered, I usually refer them to our local Dynasplint
reps. Private insurance may pay for the Ultraflex systems. EMPI has
these systems and will sell to orthotists, but you are reimbursed on a
monthly rental basis. I tried this once, but these patients need
follow-up on a regular basis and many have difficulty getting to your
office, so look at travel costs as part of your expenses. One patient
died and I could not get the device returned from the survivors.
Dynasplint reps do a good job in my area and I get referrals from them
now and again for definitive orthoses.
I have done the Dynasplint rental thing long ago and was very
disappointed as we do not have a method for rental and the device was
marginal. I have used Ultraflex and they have very nice units and now
new joints and lock outs. I would suggest to the physician as I am
certain they have no idea which is best. They are relying on you for
insight as you already know. Its like Kleenex, TED hose etc.
I find that Dynasplint has a very effective marketing network. Often
times I get a prescription specifically ordering the Dynasplint. I will
make a call, or visit the physician ordering the orthosis and make an
effective case AGAINST the Dynasplint and tell of the advantages of the
Ultraflex System. Thus far I have never been denied. To me , clearly
the advantages greatly outweigh in favor of the Ultraflex. Thus far
this year I have used over 20 Ultraflex. I do not use the OTS---I use
the custom 100%. Reimbursement can be a problem when it comes to the
power unit but thus far I think for the power unit at least our cost has
been covered. I personally do not have any desire to enter the rental
arena, of course using only custom this would rule out rental.
One of our recent Ultraflex clients was able to walk to the lectern with
bilateral stance phase Ultraflex KAFOs and receive her PhD at Baylor. I
was sure happy for her.
Citation
Randy McFarland, “Dynamic orthoses billing RESPONSES,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/229184.
