Detail regarding prosthetic audits
Wil
Description
Collection
Title:
Detail regarding prosthetic audits
Creator:
Wil
Date:
9/21/2012
Text:
Hello Colleagues and Guests,
As the audit rejection causes become more evident, in addition to
missing physician documentation, we are finding two more areas of
concern. These are the power chair and oxygen complications. If you read
the Power Mobility Devices LCD, you will note that A through C must be
met in order to obtain a power chair. Many of our clients have power
chairs and we believe this is a reasonable adjunct for their ambulation
needs with prostheses and orthoses. The same may be true for oxygen, but
I have not looked at the regulations regarding that just yet. I am not
saying that Medicare rejects a claim based solely upon these issues, but
we know that they are flag raising factors in their reviews for medical
necessity.
What is the opinion of our O&P practitioners? Do you believe that a
power chair and oxygen should be a determining factor as to whether a
patient is qualified for lower limb prostheses or orthoses?
I believe this is an issue that we will have to tackle with Medicare in
the not-too-distant future and we would like to hear your opinions and
suggestions for direction in approaching this issue with Medicare. This
was an issue a few years ago, but it seemed to disappear as a problem.
I'm not sure what the deal was on that. Lift chairs were also an issue
at one time.
Anyway, thanks again for your help and feedback.
Wil Haines, CPO
MaxCare Bionics
Avon, IN
As the audit rejection causes become more evident, in addition to
missing physician documentation, we are finding two more areas of
concern. These are the power chair and oxygen complications. If you read
the Power Mobility Devices LCD, you will note that A through C must be
met in order to obtain a power chair. Many of our clients have power
chairs and we believe this is a reasonable adjunct for their ambulation
needs with prostheses and orthoses. The same may be true for oxygen, but
I have not looked at the regulations regarding that just yet. I am not
saying that Medicare rejects a claim based solely upon these issues, but
we know that they are flag raising factors in their reviews for medical
necessity.
What is the opinion of our O&P practitioners? Do you believe that a
power chair and oxygen should be a determining factor as to whether a
patient is qualified for lower limb prostheses or orthoses?
I believe this is an issue that we will have to tackle with Medicare in
the not-too-distant future and we would like to hear your opinions and
suggestions for direction in approaching this issue with Medicare. This
was an issue a few years ago, but it seemed to disappear as a problem.
I'm not sure what the deal was on that. Lift chairs were also an issue
at one time.
Anyway, thanks again for your help and feedback.
Wil Haines, CPO
MaxCare Bionics
Avon, IN
Citation
Wil, “Detail regarding prosthetic audits,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/233931.
