Tuesday, June 18, 2024

Re: Rx, Brand Names, and Billing question



We have had the same problem, with doctors ordering a named brand ankle
brace, which is patented, trade marked, and registered. But we still have
facilities who think they can make it. Most of the time its the doctor who
contacts us and asks us to look at the brace in question to see why it
is not working like it should.

When this happens, we have the patient send us the brace in question, or
bring it in if there in the area.. If it is not our brace we have the
patient go back to the facility that cast and fit the “copy-cat brace” and
get a copy of there records on file.

We then recast the patient at our expense, and make her a new brace, We then
send the patient back to her doctor with both braces and her records in
hand. The doctor contacts the facility in question, and this does not happen
again if they want to keep his referral base.

If it gets to be a real problem we go directly to there insurance carrier,
with records in hand, I believe they call this fraud.

Charles L. Eral
Marketing Manager
Arizona AFO

—– Original Message —–
From: “The Kogans”
Sent: Monday, January 21, 2002 7:44 AM
Subject: [OANDP-L] Rx, Brand Names, and Billing question

> It was my impression that if a physician put onto a precription a brand
> item, we (under the law) were obligated to honor this. Is this not so? I
> worked at another facility that laminates every orthotic brace including
> PLS-AFOs just cause it reimburses higher. When I started working there, my
> physicians were expected to recieve thermoplastic braces. I specifically
> asked them to write on the precription “thermoplastic”. My boss back then
> would just dismiss it and laminate it anyway. Does this fall under the
> of do what is written on the Rx or do what the doc wants functionally?
> On a different note:
> I just downloaded the 2002 Medicare fee schedule. I would like to find an
> Up-to-date code list for the items that medicare does not cover with 2001
> 2002 prices for the northern east coast, NJ preferred.
> Thanks,
> Mike Kogan, CP
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