LCD for Lower Limb Prosthetics
Eric Eisenberg
Description
Collection
Title:
LCD for Lower Limb Prosthetics
Creator:
Eric Eisenberg
Date:
1/23/2013
Text:
Dear List,
Reading the CMS Local Coverage Determination (LCD) for Lower Limb Prostheses (L11442) under the section titled Medical record Information (PIM 5.7-5.9) it would appear physician owned practices are taking a huge financial risk. The LCD states Records from suppliers or healthcare professionals with a financial interest in the claim outcome are not considered sufficient by themselves for the purpose of determining that an item is reasonable and necessary.
Isn't a physician who owns a prosthetic and orthotic practice to which he refers patients a healthcare professional with a financial interest in the claim outcome? These physicians are using there own prescriptions and clinic notes to justify prostheses for which they have a direct financial interest.
Since these physicians in these scenarios have now become our competitors is there something that can be done? As we as an industry are coming under greater and greater scrutiny for documentation by auditors seems based on the LCD the auditors could recoup ALL the money from physician owned practices. What do you all think??
Eric S. Eisenberg M.S.;C.P.O.
BioTech limb and Brace LLC
Reading the CMS Local Coverage Determination (LCD) for Lower Limb Prostheses (L11442) under the section titled Medical record Information (PIM 5.7-5.9) it would appear physician owned practices are taking a huge financial risk. The LCD states Records from suppliers or healthcare professionals with a financial interest in the claim outcome are not considered sufficient by themselves for the purpose of determining that an item is reasonable and necessary.
Isn't a physician who owns a prosthetic and orthotic practice to which he refers patients a healthcare professional with a financial interest in the claim outcome? These physicians are using there own prescriptions and clinic notes to justify prostheses for which they have a direct financial interest.
Since these physicians in these scenarios have now become our competitors is there something that can be done? As we as an industry are coming under greater and greater scrutiny for documentation by auditors seems based on the LCD the auditors could recoup ALL the money from physician owned practices. What do you all think??
Eric S. Eisenberg M.S.;C.P.O.
BioTech limb and Brace LLC
Citation
Eric Eisenberg, “LCD for Lower Limb Prosthetics,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 23, 2024, https://library.drfop.org/items/show/234502.
