NovaCare Prosthetics & Orthotics

As a physical therapist working in the prosthetic and orthotics industry for the last 13 years, it has been difficult to watch the professionals who provide prosthetic care battle for recognition. Within the eyes of Medicare, well-trained prosthetists must still rely on physician documentation in order to deliver a prosthetic to their patient and get paid for the work completed.

To become licensed, prosthetists must complete a master’s degree and an 18-to-24-month residency. Once finished with residency, they are then required to take a written and practical exam. However, their education, training and expertise — essentially, their documentation — is still not good enough to stand alone in Medicare’s eyes.

There was a time when this was not the educational requirement for being a prosthetist, but those days are long gone. The orthotics and prosthetics profession is overseen by two certifying bodies: the American Board of Certification (ABC) in Orthotics, Prosthetics & Pedorthics, Inc., and the Board of Certification (BOC).

In 1948, ABC required prosthetists and orthotists to have a bachelor’s degree. In 2012, they changed that requirement to a master’s degree. If you did not have a college degree, you could become a prosthetist from on-the-job-training and certification through BOC. In 2016, BOC stopped accepting applications for new orthotists and prosthetists. This meant such professionals could only be certified through ABC, thus requiring a master’s degree. ABC ensures that not only the prosthetists working are licensed appropriately, but their facilities are as well.

Given the changes in educational requirements in the prosthetic field, it is time to also change the physician documentation requirement for delivering a prosthetic. After all, we have many other health care professions who require the same education level but who do not need a physician’s order to complete patient care.

"It is time to let the prosthetist’s expertise and notes be enough to deliver patient care"

In the prosthetic world, prosthetists are required to have an initial written order from the physician to start the process. After the patient has been seen for a comprehensive initial evaluation, a detailed written order — similar to a physical therapist’s plan of care — is completed by the practitioner. This outlines exactly what they intend to provide the patient, including the billing codes, and is required for all insurances, not just Medicare.

Medicare says that is not enough. They require the physician’s documentation (which the prosthetist must track down) be included in the submission process to get authorization. 

Why isn’t the initial order or detailed written order enough? 

Getting the physician documentation to express what Medicare is requiring is not as easy as it sounds. It can cause a delay in patient care. Moreover, all the information Medicare is looking for can be found within the prosthetist’s evaluation and visit notes.

It is time for Medicare to elevate the prosthetist’s documentation by accepting it as enough to provide the specialized care they deliver to the patient. 

Once the physician signs off on their initial script and the detailed written order, Medicare should evaluate the need for a prosthetic device solely on the documentation of the prosthetist. This would ensure they have the initial prescription from the physician, and that the prosthetist documentation addresses all of the items required for authorization.

Patients are suffering and not receiving timely care due to Medicare’s current requirement. It is time to let the prosthetist’s expertise and notes be enough to deliver patient care.