Re: Doctors doing there own Orthotics and Prosthetics
Joyce Perrone
Description
Collection
Title:
Re: Doctors doing there own Orthotics and Prosthetics
Creator:
Joyce Perrone
Date:
9/1/2011
Text:
Here are a few points on some of the new models out there.
1. It is legal for a physician to own an O&P practice. An O&P practice can not Employee a doctor, though
2. O&P does not come under stark. DME does (e-codes, for instance)
3 No one can pay for referrals - that is against the OIG and illegal. I have some concerns about manufacturers who are doing the billing for the device and financially incentivizing O&P companies based on referrals sent to them.
4. You can have a clinic in a practice and then pay for use of the space, staff, etc - but you better be able to prove that you have documented the costs as fair-market-value (FMV). This means have a copy of their lease or documentation from a realtor as to FMW. If you are paying for staff, again, you have to have documentation you can back with the amount of time and cost.
Reality is that Medicare is planning cuts to physician revenue. The physicians are going to look wherever they can to gain it back. Locally, some of the other insurance companies may NOT allow an Orthopedic practice to bill for custom, for example. Now that doesn't stop some from billing it anyway and it slips through. I recommend you talk to your local carriers about their regulations. Probably after a few years of seeing increased utilization - which always happens with these things - the government may step back in and change the laws. In the meantime, it is important for o&p companies to sit down and do some strategic planning. This is only going to get bigger and shrink your revenue streams- first for off-the-shelf, then for custom. I think prosthetics is more secure, at this point in time.
Joyce J. Perrone
De La Torre O&P, Inc
PROMISE Consulting, Inc.
300 Alpha Drive, Pgh PA 15238
412-849-7750
<Email Address Redacted> www.delatorreop.com
-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On Behalf Of Eric Eisenberg
Sent: Thursday, September 01, 2011 6:18 AM
To: <Email Address Redacted>
Subject: [OANDP-L] Doctors doing there own Orthotics and Prosthetics
Dear List,
Please provide input regarding the following ie: is this legal/ethical:
In our area we seem to have O and P companies who have their own clinics going around setting up additional clinics in physicians offices where the physician is highly compensated for all referrals. I don't know the specifics but what I gather is the way around the stark violations and anti kickback statute is they set up a practice owned by the physician. The O an P guys then lease themselves to the physician owned O and P practice and are compensated by the physician for their services. Since the physician owns the practice no referral is being made. Is anyone familiar with such arrangements? Can anything be done about such arrangements? Is this where O and P is heading either you work for a physician or you pay the physician for referrals? We have all seen Orthopedists who have bracing specialists in there offices, now its prosthetics how will honest O and P practices survive?
Eric S. Eisenberg M.S.: C.P.O.
BioTech Limb and Brace LLC
1. It is legal for a physician to own an O&P practice. An O&P practice can not Employee a doctor, though
2. O&P does not come under stark. DME does (e-codes, for instance)
3 No one can pay for referrals - that is against the OIG and illegal. I have some concerns about manufacturers who are doing the billing for the device and financially incentivizing O&P companies based on referrals sent to them.
4. You can have a clinic in a practice and then pay for use of the space, staff, etc - but you better be able to prove that you have documented the costs as fair-market-value (FMV). This means have a copy of their lease or documentation from a realtor as to FMW. If you are paying for staff, again, you have to have documentation you can back with the amount of time and cost.
Reality is that Medicare is planning cuts to physician revenue. The physicians are going to look wherever they can to gain it back. Locally, some of the other insurance companies may NOT allow an Orthopedic practice to bill for custom, for example. Now that doesn't stop some from billing it anyway and it slips through. I recommend you talk to your local carriers about their regulations. Probably after a few years of seeing increased utilization - which always happens with these things - the government may step back in and change the laws. In the meantime, it is important for o&p companies to sit down and do some strategic planning. This is only going to get bigger and shrink your revenue streams- first for off-the-shelf, then for custom. I think prosthetics is more secure, at this point in time.
Joyce J. Perrone
De La Torre O&P, Inc
PROMISE Consulting, Inc.
300 Alpha Drive, Pgh PA 15238
412-849-7750
<Email Address Redacted> www.delatorreop.com
-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On Behalf Of Eric Eisenberg
Sent: Thursday, September 01, 2011 6:18 AM
To: <Email Address Redacted>
Subject: [OANDP-L] Doctors doing there own Orthotics and Prosthetics
Dear List,
Please provide input regarding the following ie: is this legal/ethical:
In our area we seem to have O and P companies who have their own clinics going around setting up additional clinics in physicians offices where the physician is highly compensated for all referrals. I don't know the specifics but what I gather is the way around the stark violations and anti kickback statute is they set up a practice owned by the physician. The O an P guys then lease themselves to the physician owned O and P practice and are compensated by the physician for their services. Since the physician owns the practice no referral is being made. Is anyone familiar with such arrangements? Can anything be done about such arrangements? Is this where O and P is heading either you work for a physician or you pay the physician for referrals? We have all seen Orthopedists who have bracing specialists in there offices, now its prosthetics how will honest O and P practices survive?
Eric S. Eisenberg M.S.: C.P.O.
BioTech Limb and Brace LLC
Citation
Joyce Perrone, “Re: Doctors doing there own Orthotics and Prosthetics,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/232925.
