Friday, May 20, 2022

Proposed Lower Limb Prosthetic Documentation – Draft

Wil Haines

Hello Colleagues and Guests,

I’ve posted a Microsoft Word version of the CMS Draft Proposal for a
physician electronic template regarding lower limb prostheses. A copy of
this document will be forwarded to CMS for their review and
consideration. Some may disagree with my thoughts, but that’s okay,
everyone has their own opinion. You can find the document at the website, under documents, CMS, and then CMS Proposed
Documentation Template – DRAFT. If you open the document in Word and
change the review tab to original, you will see the CMS version pretty
much as they released it. I had to scan the CMS version of the document,
so it is not 100% original, but it is 99.999 percent content correct,
minus the CMS formatting. I’m not sure how to save the document without
the changes. Maybe CMS would provide an original Word copy to you upon

As many of you know, CMS is trying to get information regarding this
important lower limb prosthetic documentation matter and has hosted a
couple of open phone calls regarding same. I sat in on the very first
one as a listener.

As we move down the road, this information may possibly become the
make-or-break factor for Medicare eligible lower limb amputees.
Therefore, I think it is very important that we consider the language
and requirements set forth in the CMS proposed policy. The document that
I have posted includes all my mark-up and revision suggestions. For the
most part, my remarks are self-explanatory and I make no apology for my
bluntness. One thing that I want to emphasize though is the word
ambulation. One can ambulate in a wheelchair, or on roller skates for
that matter, so I’ve gone to lengths to correct the usage of this word
and make it very clear that we are talking about ‘walking’ with a
prosthesis. I believe ‘walking’ takes the mystery and opportunity for
play on words out of the picture.

From what I have read and digested so far, I also believe it is
apparent that CMS and its officials want much tighter controls on
prosthetic prescriptions and their proposed draft document supports that
opinion. As I see it, CMS wants definitive ‘proof’ of prosthetic medical
necessity and functional potentials and their template forces the
information far beyond the scope that is provided by the typical
physician who writes prosthetic prescriptions. To be quite honest, I
think this might be a very good thing. Having patients report to various
specialty clinics to obtain definitive medical markers regarding
prosthetic care would be beneficial provided that it relieves the
prosthetist of having to defend the care that is ultimately provided. It
also puts more responsibility upon other medical practitioners who
evidently know more than the prosthetist about functional potentials. I
also believe most physicians who prescribe prosthetic care would be
pleased to see their paperwork burden reduced and placed in specialty
clinics where it belongs. At the end of the day, the prosthetic
prescription has to be a CMS preordained and approved definitive work
that exonerates the prosthetist from liability for the prosthetic
services provided, assuming they provide appropriate care within the
prescribed functional level. In my mind, nothing else will be
acceptable, short of allowing the prosthetist authority to make the
functional level judgement. That is not likely to happen, so the only
logical and acceptable solution should be a pre-approved CMS prosthetic
prescription. The CMS template draft seems to support that opinion as well.

Another unspoken matter that comes into play here is the professional
and personal liability issue. When CMS develops policies that dictate
what and when a prosthetic device is eligible for repair or replacement,
along with the physiological patient ramifications that might come from
their decision, liability becomes a major issue. As prosthetists and
orthotists, we have full responsibility for our decision making when it
comes to replacing or repairing components and the consequential
liabilities rest fully on our shoulders, once we are made aware of the
potential problem issues. If this responsibility is intercepted by CMS,
our liability issues should diminish accordingly, or prosthetic services
will be eliminated for some deserving Medicare citizens who cannot
afford to pay for our services otherwise outside the Medicare program. I
realize this issue will require a considerable amount of thought and
advise from legal experts, but the issue is nonetheless there.

I believe several O&P folks should review the CMS template proposal and
offer opinions about same. If we don’t get involved, Medicare will march
on without us and the consequences might be even more harmful than the
problems that we are already facing.

I hope some will take the time to give their opinions to CMS. Thanks for
your time and consideration.

Wil Haines, CPO
MaxCare Bionics
Avon, IN 46123


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