Fwd: BCBS Corporate Medical policy for MPKs
jeffrey mcdonald
Description
Collection
Title:
Fwd: BCBS Corporate Medical policy for MPKs
Creator:
jeffrey mcdonald
Date:
8/28/2014
Text:
From: jeffrey mcdonald < <Email Address Redacted> >
Date: Thu, Aug 28, 2014 at 11:54 AM
Subject: BCBS Corporate Medical policy for MPKs
To: <Email Address Redacted>
Greetings List,
In the BCBS of NC Corporate Medical policy for MPKs there is a paragraph on
pg 3 that reads; Reimbursement for microprocessor-controlled knees may
only occur if there is a documented evaluation by a trained prosthetic
clinician. The clinician performing the evaluation may not be an employee
of or have a financial relationship with the supplier of the device.
I am interested in hearing from any of you who have had an outside
clinician perform the evaluation.
1. Was the evaluation done by a colleague/competitor?
2. Assuming the evaluation is not FREE, what is the usual and customary
charge for the eval?
3. If clinician is paid, would the contract not constitute a financial
relationship with the supplier? (Devil's advocate)
4. Is there a National/State list of clinicians who are available to
perform MPK evals?
5. If the claim is denied based on the clinician's evaluation, does the
supplier have any recourse with the clinician?
a. Does the evaluating clinician have ANY liability?
--
Jeffrey L. McDonald CP
Atlantic Prosthetic Services
Wilmington, NC 28412
o 910.350.0067
c 910.540.5798
--
Jeffrey L. McDonald CP
Atlantic Prosthetic Services
Wilmington, NC 28412
o 910.350.0067
c 910.540.5798
Date: Thu, Aug 28, 2014 at 11:54 AM
Subject: BCBS Corporate Medical policy for MPKs
To: <Email Address Redacted>
Greetings List,
In the BCBS of NC Corporate Medical policy for MPKs there is a paragraph on
pg 3 that reads; Reimbursement for microprocessor-controlled knees may
only occur if there is a documented evaluation by a trained prosthetic
clinician. The clinician performing the evaluation may not be an employee
of or have a financial relationship with the supplier of the device.
I am interested in hearing from any of you who have had an outside
clinician perform the evaluation.
1. Was the evaluation done by a colleague/competitor?
2. Assuming the evaluation is not FREE, what is the usual and customary
charge for the eval?
3. If clinician is paid, would the contract not constitute a financial
relationship with the supplier? (Devil's advocate)
4. Is there a National/State list of clinicians who are available to
perform MPK evals?
5. If the claim is denied based on the clinician's evaluation, does the
supplier have any recourse with the clinician?
a. Does the evaluating clinician have ANY liability?
--
Jeffrey L. McDonald CP
Atlantic Prosthetic Services
Wilmington, NC 28412
o 910.350.0067
c 910.540.5798
--
Jeffrey L. McDonald CP
Atlantic Prosthetic Services
Wilmington, NC 28412
o 910.350.0067
c 910.540.5798
Citation
jeffrey mcdonald, “Fwd: BCBS Corporate Medical policy for MPKs,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/236643.
