Prosthetics is a completely different animal in the health care jungle in that prosthetists are not reimbursed on a fee-for-service payment as Medical Doctors/Providers. They are reimbursed per device, after delivery of that device. A practitioner can see one patient several times for their prostheses, but the reimbursement rate is the same. More complex situations needing more follow-up care isn’t reimbursed. The initial consultation/evaluation, and any adjustments and follow up appointments are all included in the cost of the prostheses.
One of the ongoing issues for prosthetists is how to deliver timely, quality care and still be able to pay their bills with the delay in reimbursement. Additional delays are caused by uncooperative or unproductive patient appointments and the delivery of the device to the patient.
Insurance document requirements are ever changing. The archaic insurance process has many delays and obstacles that prosthetists must take in each step of the process or no payment will be made. Prosthetists are treated like durable medical equipment (DME) commodity suppliers of bed pans, wheel chairs and diabetic testing supplies instead of educated, degreed professionals who treat patients.
Another issue is the cost of the prosthetic components, which can range in the thousands of dollars. Many vendors bill on a net 30-day term, but many insurance companies do not reimburse until 45 days or longer. Practitioners pay up front for the components before receiving reimbursement from the insurance companies, which results in the practice having to finance the prostheses for weeks or months.
In addition to the delay practitioners face, the patients are also delayed in receiving their prosthesis, causing frustration and potentially a poor fitting socket due to their residual limb changing. Patients who are unable to ambulate or otherwise be physically mobile are subjected to further health issues, decreased quality of life and dissatisfaction with the prosthetist.
Please write to your local representative and support the Medicare Orthotics and Prosthetics Patient-Centered Care Act, H.R.1990, which will ensure orthotic and prosthetic (“O&P”) patients have access to quality care and will reduce fraud and abuse in the Medicare O&P benefit. Specifically, this legislation will fundamentally ensure that patients are receiving the best quality care by licensed, credentialed, and trained professionals, guarantee that patient care is easily accessible, and reduce fraud and abuse that carries both a patient care and financial cost.