The Cat Needs To Come Out Of The Bag
Wil Haines
Description
Collection
Title:
The Cat Needs To Come Out Of The Bag
Creator:
Wil Haines
Date:
10/26/2008
Text:
For a few years now, I have heard the rumors that Medicare allows
physicians and therapists to charge for such things as impression
taking, measuring, fitting, training, gait training, follow-up care,
etc., etc., all in addition to submitting fees for L-Codes when devices
are provided by these providers. Recently, there has been a few
questions regarding this matter on the ListServe. As I recall, when
Medicare implemented the L-Code system, the fees were all inclusive and
no additional charges for related services rendered were allowed on the
date that L-Code claims were submitted to Medicare. Although it has been
awhile since I investigated such matters, this is what I remember. A lot
of water has gone over the dam since I was in the thick of this stuff,
so my question now is this. Can someone point me to the Federal Register
or Code of Federal Regulations section(s) where the rules and policies
pertaining to O&P fees might be listed?.
If physicians and therapists are now allowed to submit claims for
extraneous, but related, services when providing orthotic or prosthetic
devices, perhaps the law has been changed. My guess though is that it
has not changed. If that is true and it is also true that Medicare
allows these extraneous claims from other providers, then this amounts
to discrimination against orthotists and prosthetists and it gives an
unfair competitive advantage to these other providers. If Medicare has
not been following federal statute's, there may be some options
available to orthotists and prosthetists.
When it comes to providing O&P care, there is simply no other profession
that trumps the work done by qualifiied and competent orthotists and
prosthetists. That includes impression taking, engineering, fitting of
devices, gait training, follow-up care, etc., etc., etc. So if Medicare
is allowing other groups of practitioners to submit claims for
extraneous O&P services, then I want codes for my similar services. Is
anyone in disagreement with this thinking?
Thanks for your replies.
Wil Haines, CPO
MaxCare Bionics
Indianapolis, IN
physicians and therapists to charge for such things as impression
taking, measuring, fitting, training, gait training, follow-up care,
etc., etc., all in addition to submitting fees for L-Codes when devices
are provided by these providers. Recently, there has been a few
questions regarding this matter on the ListServe. As I recall, when
Medicare implemented the L-Code system, the fees were all inclusive and
no additional charges for related services rendered were allowed on the
date that L-Code claims were submitted to Medicare. Although it has been
awhile since I investigated such matters, this is what I remember. A lot
of water has gone over the dam since I was in the thick of this stuff,
so my question now is this. Can someone point me to the Federal Register
or Code of Federal Regulations section(s) where the rules and policies
pertaining to O&P fees might be listed?.
If physicians and therapists are now allowed to submit claims for
extraneous, but related, services when providing orthotic or prosthetic
devices, perhaps the law has been changed. My guess though is that it
has not changed. If that is true and it is also true that Medicare
allows these extraneous claims from other providers, then this amounts
to discrimination against orthotists and prosthetists and it gives an
unfair competitive advantage to these other providers. If Medicare has
not been following federal statute's, there may be some options
available to orthotists and prosthetists.
When it comes to providing O&P care, there is simply no other profession
that trumps the work done by qualifiied and competent orthotists and
prosthetists. That includes impression taking, engineering, fitting of
devices, gait training, follow-up care, etc., etc., etc. So if Medicare
is allowing other groups of practitioners to submit claims for
extraneous O&P services, then I want codes for my similar services. Is
anyone in disagreement with this thinking?
Thanks for your replies.
Wil Haines, CPO
MaxCare Bionics
Indianapolis, IN
Citation
Wil Haines, “The Cat Needs To Come Out Of The Bag,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/229703.
