CMS Calls for Immediate Implementation of Acceptance of Practitioner Notes

Jun 05, 2018 | Debbie Ayres

Dear-Physician-iconIn early May, the DME MAC Medical Directors announced that they were ‘retiring’ the August 2011 Dear Physician letter on lower limb prostheses. CMS has just issued instructions for immediate implementation of the provisions requiring the recognition of orthotist and prosthetist clinical documentation as part of the medical record. A huge win for the O&P profession!

The Dear Physician letter for prostheses fundamentally changed how Medicare claims for artificial limbs were processed. Prior to the 2011 Prosthetic Dear Physician letter, practitioner notes were generally accepted as being a valuable part of the patient’s medical documentation.

The Dear Physician letter made it clear that for Medicare purposes, “it is the treating physician’s records, not those of the prosthetist’s, which are used to justify payment.” This statement and the overall tone of the Dear Physician letter, lead to years of frustration where the clinical notes of qualified, educated, certified and licensed prosthetists, were simply ignored during the claim review process. This exclusion of valuable clinical information lead to higher claim denial rates and unacceptable delays in the appeal process.

With the February 2018 passage of legislation that now requires documentation created by orthotists and prosthetists to be considered part of the patient’s medical record for medical review purposes, the Dear Physician letter was no longer consistent with the law. 

The following excerpt from a recent letter from Alec Alexander, CMS’ Director of Program Integrity, indicates that CMS “has issued instruction to the Durable Medical equipment (DME) Medicare Administrative Contractors (MAC) to implement Section 50402 of the Bipartisan Budget Act of 2018 immediately.”

Section 50402 states:
(5) DOCUMENTATION CREATED BY
17 ORTHOTISTS AND PROSTHETISTS.—For the purposes of
18 determining the reasonableness and medical neces-
19 sity of orthotics and prosthetics, documentation cre-
20 ated by an orthotist or prosthetist shall be consid-
21 ered part of the individual’s medical record to sup-
22 port documentation created by eligible professionals
23 described in section 1848(k)(3)(B).

Mr. Alexander’s letter is a clear affirmation of CMS’ commitment to recognize immediate implementation of the new statutory provisions in Section 50402, accepting the orthotist and prosthetist clinical notes as part of the individual’s medical record as to “determining the reasonableness and medical necessity of orthotics and prosthetics”, for example, the patient’s  functional level, identification of the need for repairs and identifying appropriate components based on the functional category included in the physician’s approved detailed written order.

 

View a sample of one of the Dear Physician letters indicating its retirement

Alec Alexander’s letter affirming this action.

Recommended News

Meet the 2022 ABC Student Achievement and Student Diversity Scholarship Recipients

ABC, in proud partnership with the Orthotic and Prosthetic Education and Research Foundation (OPERF), is pleased to announce the recipients of the 2022 inaugural ABC Student Achievement and Student Diversity Scholarships.

Mary Walsh-Aframe, CFm, Awarded 2022 Essentially Women Ruth Addison Award

Essentially Women (EW) presented the award to Walsh Aframe at a special ceremony during Focus Conference 2022 in Clearwater Beach, Fla. Mary is the owner and founder of The Women’s Image Center in Worcester, MA.

OPERF Announces 2022 Inaugural ABC Student Poster Prize Recipients

The Orthotic and Prosthetic Education and Research Foundation (OPERF) and the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) are proud to announce the recipients of the 2022 inaugural ABC Student Poster Prizes.

ABC and NCOPE Awarded ISPO Accreditation

ABC and NCOPE are proud to announce that the established education and certification pathway to the Certified Orthotist-Prosthetist (CPO) credential was approved as an accredited Prosthetist/Orthotist Level Pathway by ISPO.

O&P Alliance Makes Statement on Direct-to-Consumer Delivery Model

The five national organizations that comprise the Orthotic and Prosthetic (O&P) Alliance stand in strong opposition to any direct-to-consumer delivery model for the provision of custom prostheses or orthoses...

ABC 2021 Annual Report Now Available

We Are ABC. This year’s report summarizes our activities during this year. See highlights of our successes and important data on our programs.

ABC Commits $1 Million in Student Scholarships

ABC is excited to announce that it will partner with organizations such as the Orthotic and Prosthetic Education and Research Foundation (OPERF) to offer $1 million in OP&P scholarships over the next five years.

2021 OPERF/ABC Student and Resident Award Recipients Announced

OPERF and ABC are proud to announce the recipients of the 2021 OPERF/ABC Student Award for Academic Achievement and Resident Travel Award. Congratulations to these outstanding students and residents!