The New Reality: Documenting O&P Medicare Claims

The August 2011 “Dear Physician” letter sent to all physicians participating in the Medicare program and the U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) report that preceded it— “Questionable Billing by Suppliers of Lower Limb Prostheses”—is having the impact that many in the profession expected. The letter instructed physicians that the only medical records that are relevant in determining the medical necessity of prosthetic care are the physicians’ records, not the prosthetists’ clinical files. Specifically, the Dear Physician letter stated, “The prosthetist’s records must be corroborated by the information in your patient’s medical record. It is the treating physician’s records, not the prosthetist’s, which are used to justify payment.”