What constitutes pertinent information to support prosthetic levels for Medicare
Paula
Description
Collection
Title:
What constitutes pertinent information to support prosthetic levels for Medicare
Creator:
Paula
Date:
5/24/2011
Text:
Hello List,
I am looking for ideas and suggestions of how others are handling
documentation requirements and functional justification for Medicare.
Region A has instituted a pre-payment probe for lower limb prosthesis on
K3 levels and above.
Our biggest issue is what are you getting from the physicians or what are
you obtaining for supporting documentation? We often times have patients
are referred by the surgeons who do not go to rehab, do not have PT
services..do we now need to require that these patients receive more
services to justify what we provide them so that we have supporting medical
records? Do we tell the doctors that they now need order physical therapy
or refer the patients to the physiatrist clinic?
We are currently revamping our evaluation tools and establishing new
documentation guidelines but we felt that (until now, that we are compliant
with detailed orders, practitioner evaluations, SOAP notes, proof of
deliveries but it's the supporting documentation we are worried about?
Ideas and strategies of what other practices are doing would be appreciated.
The joy of an LCD from Medicare is that they do not give you specific
criteria, it is all open to interpretation. I would rather have a PA
process in place or have a standardized list/format for what is required
that would make like much easier.the response of obtain an ABN is ludicrous
in our opinion because sure you can make the patient sign the ABN but will
they have the means to pay the bill if Medicare denies their claim!
Any insight and specifics would be appreciated to ease our anxiety!
Thank you..I will share information if requested.
Paula Rogerson-Doherty
Business & Administrative Manager
Rogerson Orthopedic ~ Advanced Orthotic & Prosthetic Services
483 Southampton Street - PO Box 493
Boston, MA 02127
Ph: (617) 268-1135 Fx: (617) 269-3373
< <URL Redacted>> www.rogersonorthopedic.com
I am looking for ideas and suggestions of how others are handling
documentation requirements and functional justification for Medicare.
Region A has instituted a pre-payment probe for lower limb prosthesis on
K3 levels and above.
Our biggest issue is what are you getting from the physicians or what are
you obtaining for supporting documentation? We often times have patients
are referred by the surgeons who do not go to rehab, do not have PT
services..do we now need to require that these patients receive more
services to justify what we provide them so that we have supporting medical
records? Do we tell the doctors that they now need order physical therapy
or refer the patients to the physiatrist clinic?
We are currently revamping our evaluation tools and establishing new
documentation guidelines but we felt that (until now, that we are compliant
with detailed orders, practitioner evaluations, SOAP notes, proof of
deliveries but it's the supporting documentation we are worried about?
Ideas and strategies of what other practices are doing would be appreciated.
The joy of an LCD from Medicare is that they do not give you specific
criteria, it is all open to interpretation. I would rather have a PA
process in place or have a standardized list/format for what is required
that would make like much easier.the response of obtain an ABN is ludicrous
in our opinion because sure you can make the patient sign the ABN but will
they have the means to pay the bill if Medicare denies their claim!
Any insight and specifics would be appreciated to ease our anxiety!
Thank you..I will share information if requested.
Paula Rogerson-Doherty
Business & Administrative Manager
Rogerson Orthopedic ~ Advanced Orthotic & Prosthetic Services
483 Southampton Street - PO Box 493
Boston, MA 02127
Ph: (617) 268-1135 Fx: (617) 269-3373
< <URL Redacted>> www.rogersonorthopedic.com
Citation
Paula, “What constitutes pertinent information to support prosthetic levels for Medicare,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/232660.
