Understanding the LCD for Lower Limb Prosthetics
Kip Hicks
Description
Collection
Title:
Understanding the LCD for Lower Limb Prosthetics
Creator:
Kip Hicks
Date:
1/25/2013
Text:
I hope the below helps in the misreading of the
Dear List,
I hope the below helps in the misreading of the LCD.
The full text:
“Information contained directly in the contemporaneous medical record is the source required to justify payment except as noted elsewhere for prescriptions and CMNs. The medical recordis not limited to physician’s office records but may include records from hospitals, nursing facilities, home health agencies, other healthcare professionals, etc. (not all-inclusive). 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.” (Emphasis added.)
It is clear from the context that “healthcare professionals” is not a reference to physicians. And “records” is not a reference to “medical record.” All CMS is saying is that you have to have a medical record, that is, a physician’s prescription, which what the Alabama O&P Act requires. Moreover, the licensed practitioner has to evaluate and formulate a plan of care. So it is not the “record” or even the “medical record” by themselves that is provided for support the reasonable and necessary determination.
I hope this helps in the proper interpretation of the cited LCD.
Kindest Regards,
Kip Hicks, CPO/LPO-CMCO
________________________________
From: Eric Eisenberg < <Email Address Redacted> >
To: <Email Address Redacted>
Sent: Wednesday, January 23, 2013 10:43 AM
Subject: [OANDP-L] LCD for Lower Limb Prosthetics
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
Dear List,
I hope the below helps in the misreading of the LCD.
The full text:
“Information contained directly in the contemporaneous medical record is the source required to justify payment except as noted elsewhere for prescriptions and CMNs. The medical recordis not limited to physician’s office records but may include records from hospitals, nursing facilities, home health agencies, other healthcare professionals, etc. (not all-inclusive). 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.” (Emphasis added.)
It is clear from the context that “healthcare professionals” is not a reference to physicians. And “records” is not a reference to “medical record.” All CMS is saying is that you have to have a medical record, that is, a physician’s prescription, which what the Alabama O&P Act requires. Moreover, the licensed practitioner has to evaluate and formulate a plan of care. So it is not the “record” or even the “medical record” by themselves that is provided for support the reasonable and necessary determination.
I hope this helps in the proper interpretation of the cited LCD.
Kindest Regards,
Kip Hicks, CPO/LPO-CMCO
________________________________
From: Eric Eisenberg < <Email Address Redacted> >
To: <Email Address Redacted>
Sent: Wednesday, January 23, 2013 10:43 AM
Subject: [OANDP-L] LCD for Lower Limb Prosthetics
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
Citation
Kip Hicks, “Understanding the LCD for Lower Limb Prosthetics,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 23, 2024, https://library.drfop.org/items/show/234608.
