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Common Problems with Orthotics Bracing Documentation – and How to Fix Them

Suppliers and practitioners alike experience frustration and roadblocks when completing orthotic bracing documentation for patients.

Here are some common pain points felt throughout the industry, and some helpful ways to address them.

Problem #1: Lack of Complete and Correct Documentation

Have you ever been engaged in a game of ping pong over insufficient documentation for orthotic bracing?

Most suppliers have a difficult time getting thorough orthotic brace documentation from prescribing practitioners.  Most prescribers and their staff are frustrated with the requests for additional documents to substantiate the order.

While practitioners are well-versed in diagnostics, they are typically unaware of documentation guidelines needed to support a claim for the item they are attempting to order.

This creates a timely back and forth that causes friction between the prescriber and the supplier.  It is a time suck for everyone, and it can even delay the patient receiving a needed medical supply.

There are a few things that can be done to alleviate everyone’s stress.  Here are a couple possible solutions.

Problem #2: Lack of Orthotics Documentation Tools within an EHR

Prescribing practitioners currently use structured EHR’s for most of their patient documentation needs. EHR software is not created to ensure that chart notes contain necessary criteria for DME items, and they lack the flexibility needed for a patient’s specific plan of care regarding DME.

An EHR is geared toward a medical practices basic documentation needs and orders for pharmaceutical prescriptions, referrals to specialists, imaging, and labs.  Unfortunately, documentation for orthotic bracing and other complex DME items aren’t currently including solved for with the vast majority of currently available EHR software.

Due to this, presently, suppliers make a request to the ordering medical practice for chart notes to substantiate medical necessity. They know that odds are they will either receive nothing or weak notes that will put them at risk if they supply the ordered item and are audited.

This puts them in the position of either taking a big risk by fulfilling the order with insufficient chart notes, not supplying the item the practitioner ordered for the patient, asking that the patient to be sent to a physical therapist for evaluation for the orthotic brace, or having the patient go in for an additional visit and hoping for better notes. This isn’t a great system for any party.

Solution #1: The Manual Checklist

Medicare has created several documentation checklists for orthotic bracing and other DME.  These provide brace classifications (OTS, Custom Fit and Custom Fabricated), HCPCS codes, and other helpful information required for documenting medical necessity for each type of orthotic.

Currently, these checklists are available for spinal, knee and ankle orthotics and can be accessed at https://med.noridianmedicare.com/web/jadme/policies/documentation-checklists.

These checklists can be submitted to the ordering clinician when the supplier makes a request for chart notes pertaining to medical necessity of the ordered item.  This will allow the clinician to review his or her notes to determine proper and complete evaluation of the patient.

If information is lacking, they can schedule a subsequent visit with the patient or write a prescription for a physical therapy evaluation for the ordered item.

For suppliers wanting a faster, time-saving solution that assists the clinician during the evaluation, software solutions should be considered.

Solution #2: The Software Solution

The most comprehensive solution to these ongoing frustrations is a web-based software, like HealthSplash‘s SplashRx that is built to walk the ordering practitioner through the required questions and objective tests needed to determine medical necessity.

The software’s orthotics exam documentation is built based upon LCD criteria (when applicable).  It seamlessly walks the examining clinician step-by-step through requirements to appropriately assess the patient for an orthotic brace.

This massively reduces the clinician’s distress and confusion regarding necessary documentation for approval, and it works in conjunction with the medical practice’s EHR.

The software eliminates antiquated procedures such as faxing completed documentation.  It also provides a streamlined process for addendum requests.

All of these benefits save valuable time for both the medical practice and the supplier so that more time can be spent with their other patients.

On the Horizon

In the future, be on the lookout for extensive technology-based solutions that eradicate documentation frustrations across the industry. Customizable workflows that work in conjunction with all providers’ and suppliers’ software will soon be available for all areas of medical equipment, not just orthotics.

By |2020-10-01T05:40:12+00:00December 26th, 2018|Documentation, Uncategorized|0 Comments

About the Author:

Joyce has an extensive and diverse background in Systems Management for healthcare, including physician practice management, DME supplier company management, medical billing, physician EMR systems, and medicare and commercial payer compliance. Joyce has been particularly successful in assisting physician practices, outpatient surgery centers, DME companies, and software companies increase their revenues and profitability while maintaining regulations and HIPAA Compliance requirements for Medicare, Medicaid, Private Insurance, Workman’s Comp and other insurance programs. Her experience with HIPAA and Medicare LCD requirements has been a vital resource in assisting in the development of exam and documentation compliance protocols for healthcare entities, and she has assisted physician and DME supplier organizations in meeting billing requirements for compliance purposes. Joyce is currently Director of Compliance for HealthSplash, Inc.

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