Medicare: Its Time to Start Following the Law.
Medicare: Its Time to Start Following the Law.
The Issue
The other day, an elderly amputee broke down in tears in my office because she couldn't get her doctor to write the documentation required to justify a prosthesis.
The doctor's resistance wasn't her lack of capability for walking. It wasn't that he doubted the medical necessity of the prosthesis. The reason he wouldn't write the documentation was that he didn't know what to write and didn't have the time to learn it.
For many years, Doctors have relied on prosthetic practitioners named Prosthetists to justify prostheses based on a patients functional level, interests, and health condition while a doctor was responsible for signing off on the care. In 2001, congress insured this status by requiring that a prosthesis be "furnished by qualified practitioner". However Medicare (CMS) never complied with the law, and in 2012 took steps in the opposite direction by claiming Prosthetists are only suppliers (like wheelchair salesmen) and removing their documentation from the Patient's Medical Record for purposes of prosthetic justification.
Since 2011, CMS has been allowing for-profit companies (RAC auditors) to take money back from Prosthetists for prostheses fit as far back as 2010. The main reason is lack of physician documentation. This has Prosthetists scared stiff and asking Physicians to justify everything that the Prosthetists do. Physicians can't or won't create this documentation and amputee's are going without prosthetics.
I can source every claim that I have made above. References and policy detail are listed below.
Please sign the petition if you agree and believe that Medicare should follow the law, comply with BIPA, section 427, and support amputee's in getting the prosthetic care they deserve.
Thank You
-Jeff Erenstone CPO
Statement:
I believe a certified Prosthetist is a qualified practitioner and health care professional whose assessment of prosthetic justifications and amputee functional level is currently part of the medical record as required by law.
I would like The Centers for Medicare and Medicaid Services to promulgate BIPA, Section 427 by recognizing Certified Prosthetists as qualified Prosthetic Practitioners and award them the rights and responsibilities that would be expect by allied medical practitioners. This includes but is not limited to accepting their records as part of the justification of the prosthetic care they provide.
I believe that a Certified Prosthetist is a prosthetic expert. A Physician may be required to prescribe prosthetic care and over see this care, but the knowledge and expertise of the Prosthetist is crucial for proper prosthetic care and this expertise should be acknowledged and included in the medical record.
I don't believe this request is too much to ask because by law, BIPA section 427 was supposed to be promulgated in 2002. The Office of Inspector General express concern on this topic and filed a report against CMS in 2012 titled, "CMS Has Not Promulgated Regulations To Establish Payment Requirements for Prosthetics and Custom-Fabricated Orthotics."
All I am asking is for CMS to follow a 14 year old law and officially recognize Certified Prosthetists as the medical professionals and accept their records as part of the medical records.
Background:
In 2001 Congress passed into law, BIPA (Benefits Improvement and Protection Act of 2000).
In section 427 it states that a prostheses must be “furnished by a qualified practitioner”. The effective date for this mandate was “Not later than 1 year after the date of the enactment of this Act.” That was nearly 13 years ago.
The goal of this law was to ensure that prosthetic patients received care from individuals who met strict educational and clinical standards, and that CMS only pay for care provided by such individuals. BIPA included Certified Prosthetists in their definition of “qualified practitioners”
Despite this law, in 2011 after a "Dear Physician Letter”, CMS audit contractors (RAC Auditors) began aggressively auditing prosthetic claims as far back as 2009. These for-profit companies are only paid by reclaiming payments from their audits. They started reclaiming Prosthetist’s payments due to “Lack of Medical Justification” in Physician Records, despite this care being documented in Prosthetist’s Records. Not until 2012, did the DME MACs updated their lower Limb Prosthetic LCD's to label Prosthetists as "suppliers" and remove prosthetists records from the "medical record for Medicare payment purposes" (see references below). These audits continue today and are increasing in frequency.
The only way CMS is allowed to keep Prosthetist records out of the Medical Record is by classifying them as "suppliers". A letter from a CMS official has been included in the reference section which explains their perspective. However according to numerous CMS Policies and Medicare Laws, a Medical Provider's and/or Professional's records are part of the Medical Record for billing justification purposes. One example is the Medicare Program Integrity Manual which is referenced below.
By disregarding BIPA's definition of Certified Prosthetists as "qualified practitioners", CMS is forcing prosthetic patients to rely upon their doctors ability to complete an assessment of their functional level and produce justifications for the parts for their prosthetic.
While some specialist physicians are able to complete an assessment of amputee functional level, very few physicians have the knowledge or interest in specific prosthetic components to be able to effectively justify them in their clinical record; this is why physicians refer their patients to Certified Prosthetists.
Additionally, physicians do not have the time or interest to write detailed documentation for a prosthesis especially when they are not being reimbursed for their time to do so.
Furthermore, this put an additional burden on patients who must visit their Doctor or find a Doctor willing to do prosthetic documentation. Often this appointment will be made for the exclusive purpose of having them document care that a Prosthetist provides and has already documented.
Because of the problems listed above, there are amputees who will not receive the care they deserve.
References:
http://www.mountainoandp.com/assets/pdf/dhs_letter.pdf.
https://oig.hhs.gov/oei/reports/oei-07-10-00410.asp
http://www.govtrack.us/congress/bills/106/hr5661/text
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pim83c05.pdf
The Issue
The other day, an elderly amputee broke down in tears in my office because she couldn't get her doctor to write the documentation required to justify a prosthesis.
The doctor's resistance wasn't her lack of capability for walking. It wasn't that he doubted the medical necessity of the prosthesis. The reason he wouldn't write the documentation was that he didn't know what to write and didn't have the time to learn it.
For many years, Doctors have relied on prosthetic practitioners named Prosthetists to justify prostheses based on a patients functional level, interests, and health condition while a doctor was responsible for signing off on the care. In 2001, congress insured this status by requiring that a prosthesis be "furnished by qualified practitioner". However Medicare (CMS) never complied with the law, and in 2012 took steps in the opposite direction by claiming Prosthetists are only suppliers (like wheelchair salesmen) and removing their documentation from the Patient's Medical Record for purposes of prosthetic justification.
Since 2011, CMS has been allowing for-profit companies (RAC auditors) to take money back from Prosthetists for prostheses fit as far back as 2010. The main reason is lack of physician documentation. This has Prosthetists scared stiff and asking Physicians to justify everything that the Prosthetists do. Physicians can't or won't create this documentation and amputee's are going without prosthetics.
I can source every claim that I have made above. References and policy detail are listed below.
Please sign the petition if you agree and believe that Medicare should follow the law, comply with BIPA, section 427, and support amputee's in getting the prosthetic care they deserve.
Thank You
-Jeff Erenstone CPO
Statement:
I believe a certified Prosthetist is a qualified practitioner and health care professional whose assessment of prosthetic justifications and amputee functional level is currently part of the medical record as required by law.
I would like The Centers for Medicare and Medicaid Services to promulgate BIPA, Section 427 by recognizing Certified Prosthetists as qualified Prosthetic Practitioners and award them the rights and responsibilities that would be expect by allied medical practitioners. This includes but is not limited to accepting their records as part of the justification of the prosthetic care they provide.
I believe that a Certified Prosthetist is a prosthetic expert. A Physician may be required to prescribe prosthetic care and over see this care, but the knowledge and expertise of the Prosthetist is crucial for proper prosthetic care and this expertise should be acknowledged and included in the medical record.
I don't believe this request is too much to ask because by law, BIPA section 427 was supposed to be promulgated in 2002. The Office of Inspector General express concern on this topic and filed a report against CMS in 2012 titled, "CMS Has Not Promulgated Regulations To Establish Payment Requirements for Prosthetics and Custom-Fabricated Orthotics."
All I am asking is for CMS to follow a 14 year old law and officially recognize Certified Prosthetists as the medical professionals and accept their records as part of the medical records.
Background:
In 2001 Congress passed into law, BIPA (Benefits Improvement and Protection Act of 2000).
In section 427 it states that a prostheses must be “furnished by a qualified practitioner”. The effective date for this mandate was “Not later than 1 year after the date of the enactment of this Act.” That was nearly 13 years ago.
The goal of this law was to ensure that prosthetic patients received care from individuals who met strict educational and clinical standards, and that CMS only pay for care provided by such individuals. BIPA included Certified Prosthetists in their definition of “qualified practitioners”
Despite this law, in 2011 after a "Dear Physician Letter”, CMS audit contractors (RAC Auditors) began aggressively auditing prosthetic claims as far back as 2009. These for-profit companies are only paid by reclaiming payments from their audits. They started reclaiming Prosthetist’s payments due to “Lack of Medical Justification” in Physician Records, despite this care being documented in Prosthetist’s Records. Not until 2012, did the DME MACs updated their lower Limb Prosthetic LCD's to label Prosthetists as "suppliers" and remove prosthetists records from the "medical record for Medicare payment purposes" (see references below). These audits continue today and are increasing in frequency.
The only way CMS is allowed to keep Prosthetist records out of the Medical Record is by classifying them as "suppliers". A letter from a CMS official has been included in the reference section which explains their perspective. However according to numerous CMS Policies and Medicare Laws, a Medical Provider's and/or Professional's records are part of the Medical Record for billing justification purposes. One example is the Medicare Program Integrity Manual which is referenced below.
By disregarding BIPA's definition of Certified Prosthetists as "qualified practitioners", CMS is forcing prosthetic patients to rely upon their doctors ability to complete an assessment of their functional level and produce justifications for the parts for their prosthetic.
While some specialist physicians are able to complete an assessment of amputee functional level, very few physicians have the knowledge or interest in specific prosthetic components to be able to effectively justify them in their clinical record; this is why physicians refer their patients to Certified Prosthetists.
Additionally, physicians do not have the time or interest to write detailed documentation for a prosthesis especially when they are not being reimbursed for their time to do so.
Furthermore, this put an additional burden on patients who must visit their Doctor or find a Doctor willing to do prosthetic documentation. Often this appointment will be made for the exclusive purpose of having them document care that a Prosthetist provides and has already documented.
Because of the problems listed above, there are amputees who will not receive the care they deserve.
References:
http://www.mountainoandp.com/assets/pdf/dhs_letter.pdf.
https://oig.hhs.gov/oei/reports/oei-07-10-00410.asp
http://www.govtrack.us/congress/bills/106/hr5661/text
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pim83c05.pdf
Petition Closed
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The Decision Makers
Petition created on September 24, 2013