Monday, June 17, 2024

Grandfathering K level

Ingvar Leskovar

Yesterday I posted question about Medicare grandfathering K level
established patients.
The only reason I asked was because this was mentioned to me by one of
the List respondents – and I thought, it will never hurt to check,
right?

Thank you all who responded. As I suspected, no, no such luck.

I’ll post one response that encompasses them all:

Unfortunately, it is definitely not the case. You will have to
re-establish their K-Level each and every time they need a new
relevant service. You can typically get away with it if there was a
k-level eval done within the same year but you will still need
explicit notes from the doc that the patient still meets all
functional abilities as that recent eval states. Of course, it is
always an option not to get this documentation but you run a huge risk
of the claim being denied on pre-payment review or hit again later on
a RAC audit. Not worth the risk as Medicare has made it clear they
expect new objective measures to prove the patient is still at their
prior functional ability and the device is still appropriate
(regardless of what they got in the past).

What of course makes sense.

Thank you for responses

Original question below:

Not so long ago, someone mentioned to me that Medicare is
grandfathering K-leveled patients, once established.
Is there any merit to this? I have quite a few active amputees that
are legit K-3s with Medicare, but every time I have to re-establish
their K-level. System replacements or something new.
It’d have been huge help, if true, as it saves a ton of time – and
allows to help patient faster.
I am not aware of any LCDs from Medicare about that though.

Anyone? I mean – I know our opinions. But do we have LCD or something
else for this?

Best regards

Igor Lesko, LPO

PMI Prosthetics, Seattle

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