Re: Physician Note requirements for Prosthesis

Re: Physician Note requirements for Prosthesis

8/30/2012

A year ago in Las Vegas I pointedly asked the woman staffing the medicare booth at the AOPA they meeting about how medicare was educating physicians in prosthetic patients documentation requirements. She said they were always required to document to that level. She also went on to say that there was no money in their budget for physician documentation education and it was up to me to educate my referring physicians. This was repeated at the Medicare University DME billing class I took soon after the Vegas mtg

Sent from my U.S. Cellular® Android-powered device

-----Original message-----
From: Rebecca Rogers < <Email Address Redacted> >
To: <Email Address Redacted>
Sent: Thu, Aug 30, 2012 16:25:26 GMT+00:00
Subject: Re: [OANDP-L] Physician Note requirements for Prosthesis

Mr. Gutierrez, Thank you for sharing this point with us. May I further ellaborate on your questions by posing one more: When Medicare comes out with new requirements, rules, etc. how are the Physicians made aware of these changes? I assume that there is someone, some governing body to which they all refer if they intend to be compliant with Medicare in order to continued receiving reimbursement for their service. Does ABC have a conduit of communication already established with this person/body? It has already been proven in my experience, as well as secondary through colleagues, that few physicians are receptive to receiving these updates through us as individual O&P practices and practitioners. Cheers, Rebecca Rogers, CPO, MSc


> Date: Thu, 30 Aug 2012 09:58:25 -0500
> From: <Email Address Redacted>
> Subject: [OANDP-L] Physician Note requirements for Prosthesis
> To: <Email Address Redacted>
>
> A question for all.
>
> Please review the following excerpt then see the question at the bottom
>
> According to the Medicare Program Integrity Manual Chapter 5 - Items and
> Services having Special DME Review Considerations
>
> <URL Redacted>
>
>
> Section 5.7 Documentation in the Patient's Medical Record:
> For any DMEPOS item to be covered by Medicare, the patient;s medical
> record must contain sufficient documentation of the patient's medical
> condition to substantiate the necessity for the type and quantity of
> items ordered...... The information should include the patient's
> diagnosis and other pertinent information including, but not limited to,
> duration of the patient's condition, clinical course, prognosis, nature
> and extent of functional limitations, other therapeutic interventions,
> and results, past experience with related items etc. (Can all be found
> in Dear Physician Letter August 2011)
>
> It then goes on to say:
> There _*must*_ be information in the patient's medical record that
> supports the medical necessity for the item and substantiates the
> answers on the CMN, DIF, or information on a supplier prepared statement
> or physician attestation. _
>
> __*My questions*__*are:*_
> 1. Does any of the information in this section of the document put the
> onus on the physician to have better quality notes?
> 2. Is there any ramification on the physician if their notes are not up
> to the par set in these statements and the Dear Physician letter?
> 3. Can the RAC/Pre-payment/etc (audits) that are performed on us as
> suppliers lead to an audit of a physician based on poor note quality for
> support of a DMEPOS related item?
>
> Please serious responses only, no complaints for the sake of complaining
> about the unjustness of the situation.
>
> Thank you,
>
> Tony Gutierrez
>
>
> --
> Tony Gutierrez
> Post-Resident Prosthetist
> Orthotic Prosthetic Specialists
>
>
> ********************
> To unsubscribe, send a message to: <Email Address Redacted> with
> the words UNSUB OANDP-L in the body of the
> message.
>
> If you have a problem unsubscribing,or have other
> questions, send e-mail to the moderator
> Paul E. Prusakowski,CPO at <Email Address Redacted>
>
> OANDP-L is a forum for the discussion of topics
> related to Orthotics and Prosthetics.
>
> Public commercial postings are forbidden. Responses to inquiries
> should not be sent to the entire oandp-l list. Professional credentials
> or affiliations should be used in all communications.

********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.

If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>

OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.

Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.