IN THE NEWS
The reasons for the latest denials include the following: • Lack of medical record documentation: 27 percent of the denied claims were missing the clinical documentation to corroborate the prosthetist’s records and support medical necessity. • Evaluation/assessment documentation: 8 percent of the denied claims were missing the evaluation/assessment documentation for the functional level of item(s) billed (prosthetist assessment). • Clinical documentation did not support the functional level of the lower-limb prosthesis: 31 percent of the denied claims had clinical records that did not justify the functional level of the billed item. • Proof of delivery: 15 percent of the denied claims were missing the proof of delivery. Delivery is missing items delivered, manufacturer name, and model number. The percentages above reflect the fact that a claim could have more than one missing or incomplete item. The following educational materials and links have been provided by NHIC so suppliers can be in compliance with documentation requirements:
Ferrier Coupler Options!
• Local Coverage Determination for Lower Limb Prostheses (L11464) and related Policy Article (A25310): www.medicarenhic.com/dme/medical_review/mr_lcd_current.shtml. • The DME MAC Jurisdiction A Supplier Manual (Chapter 10 includes information regarding documentation requirements): www.medicarenhic.com/dme/ suppmandownload.shtml. • Dear Physician Letter: www.medicarenhic.com/dme/ medical_review/mr_bulletins/mr_bulletin_current/phy_letter_ artificial_limbs.pdf. • Comprehensive Error Rate Testing (CERT) Errors (Monthly Publications) and CERT Physician Letter: www.medicarenhic.com/dme/dmerc_cert_rec.shtml. • Results of Widespread Prepayment Complex Review for Lower-Limb Prostheses, posted April 24, 2012; Dec. 28, 2012; and March 6, 2013: www.medicarenhic.com/dme/ medical_review/mr_bulletin_pca.shtml/. • Results of Widespread Prepayment Probe for Lower-Limb Prostheses, posted Nov. 30, 2011: www.medicarenhic.com/dme/medical_review/mr_bulletins/ mr_bulletin_pca/113011_llp.pdf. a
Interchange or Disconnect
The Ferrier Coupler provides you with options never before possible:
Enables a complete disconnect immediately below the socket in seconds without the removal of garments. Can be used where only the upper (above the Coupler) or lower (below the Coupler) portion of limb needs to be changed. Also allows for temporary limb replacement. All aluminum couplers are hard coated for enhanced durability. All models are interchangeable.
Model A5
Model F5
Model P5
The A5 Standard Coupler is for use in all lower limb prostheses. The male and female portions of the coupler bolt to any standard 4-bolt pattern component.
The F5 Coupler with female pyramid receiver is for use in all lower limb prostheses. Male portion of the coupler features a built-in female pyramid receiver. Female portion bolts to any standard 4-bolt pattern component. The Ferrier Coupler with an inverted pyramid built in. The male portion of the pyramid is built into the male portion of the coupler. Female portion bolts to any 4-bolt pattern component.
Model FA5
Model FF5
Model FP5
NEW! The FA5 coupler with 4-bolt and female pyramid is for use in all lower limb prostheses. Male portion of coupler is standard 4-bolt pattern. Female portion of coupler accepts a pyramid.
Model T5
NEW! The FF5 has a female pyramid receiver on both male and female portions of the coupler for easy connection to male pyramids.
NEW! The FP5 Coupler is for use in all lower limb prostheses. Male portion of coupler has a pyramid. The Female portion of coupler accepts a pyramid.
The Trowbridge Terra-Round foot mounts directly inside a standard 30mm pylon. The center stem exes in any direction allowing the unit to conform to uneven terrain. It is also useful in the lab when tting the prototype limb. The unit is waterproof and has a traction base pad.
AUGUST 2013 O&P ALMANAC
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