Thursday, May 26, 2022

a new dictation style for RAC


Greetings list, in addition to our evaluation forms, k-level forms, gait
assessments and all of the other redudant paperwork. I am now including a
narrative in my notes about how the RAC process is delaying critical
healthcare. I am making certain this narrative becomes part of the
patients’ medical records and demonstrating our projected time frames as if
we were allowed to provide the care needed vs. the time frames after
preparing the necessary audit style paperwork.

see my note below and please consider narrating something similar in yours.

Good luck everyone.
Chris Fairman, CPO
Great Lakes P&O
Ypsilanti, MI

——-my note this morning——-

Pt. Returns today with partial foot, Chopart style prosthesis with toe
filler. He reports a weight loss of greater than 40 lbs in last 6 months.

His mother reminds me today that when his original amputation occurred last
year October 19, 2012, he was also suffering from CHF, his legs were
swollen and his weight was 230 or more pounds. His measurements were
compared and documented along with his weight loss.

He weighs 175lbs today. Previous weight in Oct, 2012 was 230 lbs.

Upon inspection the prosthesis has a one inch gap around the entire
proximal circumference. He has the straps pulled as snug as they will
allow. There is no possible way additional padding or socks could fill this
void and maintain any sort of total contact. Digital pictures were taken
at all angles and included in his record.

This prosthesis must be remade in order to serve his needs. He is walking
for exercise to keep current with his cardio program. He gets physical
therapy twice weekly at home. He is no longer able to walk comfortably and
has had to cancel multiple therapy visits.

I asked him to revisit his physician Dr. ******l ******** for an evaluation
and recommendation for a new prosthesis due to volume and weight loss

An impression was made today to be put on hold until further direction from
physician. Although it is painfully obvious that this gentleman is using
his prosthesis daily, has a strong desire to ambulate, and is in desperate
need of a new prosthesis, I will not be able to provide this prosthesis
until we gather notes from his physicians, therapists and various other
health care providers to substantiate his need.

In the meantime he will be immobile due to the current state of healthcare,
the buracracy, and lack of efficiency in healthcare administration and the

Should his state of mental, physical and emotional health suffer during
this waiting period, I asked him to contact his representatives and present
his issues. He has already suffered one amputation due to a foot infection
as now that this current prosthesis is ill fitting he is in dire need of a
replacement. The total contact and load bearing surface areas are no longer
providing protection to his previously ulcerated heel and midfoot. In my
professional opinion he needs a replacement prosthesis immediately. Great
Lakes P&O could fabricate a new prosthesis in 3-5 days, but due to the RACs
and the inefficiencies they have created this man will likely suffer for
several weeks even months without a prosthesis, while the appropriate
paperwork is gathered, ultimately compromising his medical care. Should
another ulcer develop while he waits, I would strongly suggest he bring
legal action toward the RACs.

His RAC mandated, and redundant paperwork unfortunately now needs to
supercede his need for immediate and critical healthcare. I will relay this
information and my current evaluation to his physician in the hopes of
expediting this process.

Reviewed and electronically signed by Chris Fairman, CPO on 7/2/2013 at
10:05:52 AM.


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