In this ever-changing environment of third-party billing, government regulations, and burdensome documentation requirements, OP&P professionals are constantly seeking out every last advantage when it comes to running an efficient practice.
Most OP&P patient care facilities have entire departments of personnel dedicated exclusively to verifying insurance benefits, procuring pre-authorizations, billing claims, and following up on denied claims, all the while checking and double-checking to ensure that there is appropriate documentation and proof of medical necessity on file at every step of the process. While this support staff is essential to the function of an OP&P patient care facility, a profitable business model includes making the clinicians as efficient as possible as well, and that means maximizing the potential of patient care appointments.
The first step in making the most of a patient care appointment is ensuring that the prescription the support staff collected when scheduling the appointment is clear, concise, and well written-before the practitioner ever enters the exam room. Not only does a vague, poorly written prescription slow down the preauthorization process, but it wastes time in the exam room since the practitioner must spend valuable time playing detective to sort out exactly what the physician intended to order for the patient. We know all too well that while most practitioners appreciate and relish the autonomy, an “evaluate and treat” prescription does not pass muster when it comes to medical necessity documentation and reimbursement claim submission.
Obtaining an appropriately crafted prescription can be done any number of ways, but the following two approaches are tried and true: educating your referring physicians not only on the importance of proper prescription writing but on how to do it, or using detailed prescription request forms transmitted via electronic health records (EHR) software, fax, or mail.
Writing Footwear Prescriptions
You write prescriptions every day. You’ve probably written thousands of prescriptions for all kinds of medications. Writing a prescription for footwear, however, is quite different. So we’ve put together this quick and easy guide to help you make sure your patients get exactly the prescription footwear they need.
Why do we need a written prescription?
Authorize Treatment
Pedorthists don’t diagnose foot conditions or direct treatment in any way. We take our direction from you. So we need your authorization to provide pedorthic care.
Effective Communication
If we have your instructions in writing, we know exactly what to provide. In addition the written prescription becomes a permanent part of our patient’s record- helping with follow-up care and monitoring patient progress.
Insurance Reimbursement
We need written prescriptions so we can help your patients get reimbursements for our services. Private insurance companies, HMOs, Worker’s Compensation, Medicare, and government assistance programs require a written prescription from a physician before they will provide coverage.
Excerpt from NPS brochure, “Guidelines to Writing Footwear Prescriptions.”
Just taking a few minutes to meet with your referring physicians can pay huge dividends as far as getting comprehensive, yet easy-to-understand OP&P prescriptions. While we have all been trained in human biomechanics, anatomy, and pathology, we are not physicians and have not been involved in the patient’s medical treatment, so we need to know as much about the patient’s diagnosis as possible. The more information we receive, the better the care we can provide. While it is not realistic to expect that every referring physician understands the intricacies of what we do as orthotists, prosthetists, and pedorthists, we should reasonably be able to expect a prescription that offers us some guidance as to what the physician is expecting from us. Ideally, a well-written prescription will contain three components: what, why, and how. At National Pedorthic Services (NPS), headquartered in Milwaukee, Wisconsin, we developed a brochure to help physicians understand these components, as well as why the written prescription is important. Part of this brochure helps physicians who are not as familiar with pedorthics understand our specific treatment and documentation requirements.
Why does the patient need OP&P modalities?
Suggest that the physician include contributing systemic diseases, injury, physical disability, deficits and weaknesses, deformity, or post-operative condition in the documentation he or she sends to you. For example, the note from the physician might read: “Diabetes with severe peripheral neuropathy, recurrent plantar ulcer under right first metatarsal head (MTH), s/p left transmetatarsal amputation.”
What do you want the device(s) to accomplish?
In keeping with the example of diabetes-related foot complications, let’s look at the treatment objective section or the prescription. What is the purpose of the shoes or orthotics the physician is ordering? Knowing the diagnosis is important but we also need to understand clearly the desired effect or purpose of the modalities being requested. Is the goal to simply relieve or reduce pressure on one specific part of the foot? Does the patient need support for a flexible deformity? Is there need to restrict motion at a joint that has been injured? Are we simply looking for overall plantar foot cushioning and padding for comfort? This may be as simple as a physician’s order that reads, “Relieve pressure under plantar ulcer,” or as detailed as, “Provide filler for amputated foot, redistribute pressure from ulcerated first MTH, restrict bending motion through forefoot, and cushion and protect plantar foot.”
How do we accomplish the treatment objective?
The “How?” section of the prescription is often the most baffling for prescribing physicians. The good news is that a competent practitioner really only needs the first two components of the prescription to get through the initial evaluation. While many physicians prefer to leave the final decision on what type of device to provide up to the practitioner, any guidance given up front is helpful. Some physicians are very knowledgeable when it comes to ordering orthotic, prosthetic, and pedorthic devices and can provide complete and accurate descriptions of what they would like to have their patient receive. Others lack such in-depth awareness of the options available for their patients. For every prescription we receive that reads, “Extra-depth shoes with Velcro closures, heel-to-toe rocker soles, extended steel shanks, custom Plastazote foot orthotics with MTH offloading, and partial foot filler on L,” we get ten that read, “Shoes and inserts.”
In the case of these vague and open-ended prescriptions, the next step is to contact the physician’s office to request a detailed prescription. The method used often depends on the practitioner’s comfort level with the physician in question. If the physician is not well known to the practitioner, the best approach may be a phone call to determine whether the physician did indeed have something more specific in mind or would prefer the practitioner simply provide whatever he or she feels is appropriate. If the latter is the case, hopefully the physician is agreeable to signing a new prescription.
Another approach to obtaining a prescription with all the necessary components is to use a detailed prescription request form via EHR software, fax, or mail. When there is a high level of comfort and trust between the practitioner and physician, it is often easiest for the practitioner to generate updated prescription information for the physician, and simply fax it with a cover letter to the physician’s office for revision and a signature. Many EHR software systems are already set up to generate such documents and include things such as length of need, frequency of use, and the L-Codes for the prescribed devices.
Accurate, succinct, and complete prescriptions help improve the timeliness and efficiency of delivering the best possible OP&P services. Sometimes broaching the subject with physicians requires tact, poise, and grace in order to prevent a sense of presumptuousness or arrogance on the part of the practitioner. Ultimately, better prescriptions lead to better orthotic, prosthetic, and pedorthic care.
Dennis Janisse, CPed, is president and CEO of National Pedorthic Services, headquartered in Milwaukee, Wisconsin. He also is a clinical assistant professor in the Department of Physical Medicine and Rehabilitation at the Medical College of Wisconsin, Milwaukee; adjunct professor at the University of Pittsburgh, Pennsylvania; and director of scientific affairs for Orthofeet, Northvale, New Jersey.
