Amputee Mobility Predictor

Amputee Mobility Predictor

Jim DeWees

4/25/2014

Hello Everyone,

I have a question that I would like to find out from other prosthetists
across the US, regarding the Amputee Mobility Predictor evaluation.

- How many of us are now requiring the patient to have this evaluation
performed before we will provide any type of service?

- How many have had any resistance from physicians, and have difficulty
getting a physician to write the order, or send a referral to a physical
therapist to perform this evaluation?

- If you are using this evaluation, how many are finding it helpful? And
how is it helpful? (Does it help you have a better sense of the amputee's
functional level? Does it help with the audits? Does it help build
bridges with therapists and/or physicians? Does it cause tension between
you and physicians?)

- Have you lost business or patients because of this evaluation? Do
patients seem to be upset when they learn that they have to go through
another hoop?


From my own experience, I started using this Evaluation process in the
middle of last year (2013). I have only had a slight issue with 1 or 2
physicians who just don't like dealing with all of the additional paperwork
and more documentation, etc. It isn't specifically JUST this evaluation,
but the increase in their documentation for EVERYTHING else they are doing.

I had been getting audits on EVERY claim that was being submitted to
Medicare. (I have NEVER had any problems with Medicare (NGS) before, I had
never been audited on anything, NEVER had ANY issues with them, never had
any accusation or investigation of ANY kind, etc.) There were over 100
audits that I had to respond to, all are Pre-payment audits. The 3rd
audit I submitted was DENIED, it was a BK leg, older farmer, who is clearly
a K-3, but NGS didn't think that anyone at his age could be a K-3. It is
currently in the ALJ stage. I had another one denied due to the patient
getting a power mobility device, and I had NO idea that he had gotten this.
He is another definite K3 level amputee, 6 years walking around as a BK
amputee, and hunts, fishes, always out in the woods mushroom hunting, etc.
BUT his physician wrote documentation that he cannot walk and his upper body
strength was weak and he cannot use a manual chair. So, that is also in the
appeals.

Other than those 2 claims, I have won every other case, which is a pretty
good success rate according to the NGS medical director.

In mid-2013 I started using this Mobility Predictor evaluation, I worked
closely with a really good Physical Therapist and she learned how to
administer the evaluation, and she has also trained a few other therapists
in how to do these. I began submitting these Evaluations as part of the
Audit Packet that I had been to NGS / Medicare. It seemed to have made a
significant difference, a quicker approval or Pass with the audits.
Then as of November 2013, I started getting paid for all of my claims with
NO pre-payment audits. So I think that once they realized that I am having
EVERY patient get this evaluation, I have backed off on these pre-payment
audits.

Now, I have also started requiring that EVERY patient, not just Medicare
patients, have this Mobility Predictor done. I have heard of private
insurance companies who are now also doing audits on some of their claims.
Medicaid, at any moment, could also start doing these audits, or reviewing
old claims to audit them, and request refunds on old claims.

This has also opened some doors for me, so that I can work closer with some
therapists, and have more interaction with them. This helps in many ways to
have a more team for doing the rehab with the patients. These therapists
now feel more comfortable in calling me to ask specific questions, or to
give more helpful comments about what they are seeing with the patient when
they are working with them later in gait training and other issues. They
have also called me a few times, about other amputees in their facilities or
the hospital, or old-time prosthetic users that they feel could have a
better life if they had a newer, better prosthetic leg.

In all, the benefits and the positives for using this evaluation far
out-weigh the negatives that I have dealt with. It DOES increase the time
before I can start working with the patient, BUT it does help me with having
a piece of mind that I have a better chance of passing the audits and
getting paid for my work down the road. It is another critical piece of
documentation in the chart also, in the event that Medicare (or any other
payer), does a Recovery Audit or reviews the claim to recoup their funds.

I just wanted to ask all of you out there, if you are using this, and how it
is working out.

And, if anyone has any questions or wants information on how I have worked
this into my routine for providing services, feel free to ask me, and I
can share that too.

Thanks

Jim DeWees, CP