Contains a long set of requirements a patient must satisfy before being eligible to receive prosthetic care, including upper body strength, adequate posture, cognitive capability, sufficient neuromuscular control, sufficient cardio-vascular capacity, and numerous other prerequisites. While consideration of this medical information is not unreasonable, this appears to be a thinly veiled attempt to use the existence of these conditions to disqualify amputees for coverage of more advanced levels of prosthetic care, or any prosthetic care at all. These requirements are overly broad, not medically supported, and will lead to denials of claims based solely on historical, clinical records, not the that a physician’s judgment beneficiary is a candidate for prosthetic care; and, Reiterates misguided Medicare policies that prohibit the clinical notes from prosthetist’s being considered as part of the medical record and requires new and unnecessarily-detailed proof of delivery documentation which invites denials of prostheses already delivered to patients. This new comprehensive changes to coverage, coding and payment of lower limb prostheses LCD’s will drive practice in the future and severely limit access to modern prosthetic technology and the current standard of care. The LCD was released with absolutely no evidence cited for these major changes. When a bibliography was finally produced, it contained generic references, outdated articles, newspaper citations, and even references to legislation that has not become law. Yet, the LCD places the burden on the patient and provider community to offer evidence to rebut these proposals with a very limited timeframe. What You Can Do To Help Sign the Petition: A the has been established on the White House “We People” petition website. If 100,000 individuals sign this petition, the White House is obligated to respond. The petition can be easily accessed at . Please distribute this link to anyone you feel might be interested in signing the petition, including via Twitter, Facebook, and email. Submit Comments and Get on Record: All organizations and individuals are encouraged to submit comments to the proposed LCD by August 31st. This will ensure that the Medicare program hears widespread opposition to the proposal. Template letters and other materials to assist in commenting can be found at . Please contact us if we can be of any assistance in this matter.
Contains a long set of requirements a patient must satisfy before being eligible to receive prosthetic care, including upper body strength, adequate posture, cognitive capability, sufficient neuromuscular control, sufficient cardio-vascular capacity, and numerous other prerequisites. While consideration of this medical information is not unreasonable, this appears to be a thinly veiled attempt to use the existence of these conditions to disqualify amputees for coverage of more advanced levels of prosthetic care, or any prosthetic care at all. These requirements are overly broad, not medically supported, and will lead to denials of claims based solely on historical, clinical records, not the physician’s judgment that a beneficiary is a candidate for prosthetic care; and, Reiterates misguided Medicare policies that prohibit the prosthetist’s clinical notes from being considered as part of the medical record and requires new and unnecessarily-detailed proof of delivery documentation which invites denials of prostheses already delivered to patients. This new LCD’s comprehensive changes to coverage, coding and payment of lower limb prostheses will drive practice in the future and severely limit access to modern prosthetic technology and the current standard of care. The LCD was released with absolutely no evidence cited for these major changes. When a bibliography was finally produced, it contained generic references, outdated articles, newspaper citations, and even references to legislation that has not become law. Yet, the LCD places the burden on the patient and provider community to offer evidence to rebut these proposals with a very limited timeframe. What You Can Do To Help Sign the Petition: A “We the People” petition has been established on the White House website. If 100,000 individuals sign this petition, the White House is obligated to respond. The petition can be easily accessed at . Please distribute this link to anyone you feel might be interested in signing the petition, including via Twitter, Facebook, and email. Submit Comments and Get on Record: All organizations and individuals are encouraged to submit comments to the proposed LCD by August 31st. This will ensure that the Medicare program hears widespread opposition to the proposal. Template letters and other materials to assist in commenting can be found at . Please contact us if we can be of any assistance in this matter.
Summary%20of%20LCD%20for%20General%20Public%20(D0616021).docx