Conducting Business Under Medicare Doc. Regulations

Conducting Business Under Medicare Doc. Regulations

Dimitri Yagdjis

10/15/2013

I have been meeting with Physicians to come up with a way to address
documentation requirements for prosthetic patients under Medicare and have
hit a wall. The physician evaluation required is too lengthy to be
conducted under the available evaluation and management code; the
reimbursement is not enough. Also, the scope of the evaluation, including
nerve system, cardio-pulmonary system in addition to the physical exam, is
too broad for any one physician to comfortably conduct. I asked multiple
physicians if my facility can private pay for the exams and was turned down.
Apparently, my physicians are afraid of charging privately for things not
covered by Medicare.

Ossur's and Otto Bock's suggestions of using allied health care, such as
physical therapists to conduct the tests, only partly cover Medicare
requirements. Finally, I spoke with AOPA for advice and was told that there
is no solution as of yet. Furthermore, the current AOPA lawsuit does not
argue that the requirements are wrong, but that Medicare enacted the law
illegally, without proper oversight and so forth.

I am coming to the conclusion that it is impossible for us to provide
Medicare patients with prosthetic devices legally. Medicare can legally
take back any payments made to providers under the current circumstances.

Questions:

1) Can anyone offer a viable solution?

2) If not, is your facility still providing Medicare prosthetics under
the risk?

I will post all answers once collected.

Thank you,

Dimitri Yagdjis, CPO

Region D