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Noridian Weighs in on New Orthotists'/Prosthetists' Notes Law

Posted by David McGill | February 22, 2018

​On February 9th, we alerted you to the passage into law of a provision requiring Medicare to consider orthotists' and prosthetists' notes when making reasonableness/medical necessity determinations. Yesterday, Noridian, the DME MAC for Regions A and D, hosted a webinar that included the following statement about this new law:

"As contractors, we require CMS instructions before implementing new legislation."

What does this mean for you?

Noridian's statement makes clear that it will not change how it has historically reviewed claims unless and until it receives instructions from Medicare. What this means is that the DME MACs will continue to review claims under the old standard - i.e., orthotists'/prosthetists' notes are not part of the medical record - until CMS issues guidance on implementing the new law. 

We specifically noted in our original article about the passage of this new law that it did not render physician's notes meaningless or unnecessary. We said that "[w]e believe it remains a best practice to continue to ensure that the physician's documentation is consistent with yours." The Noridian statement validates our prior recommendation.

You should therefore continue to operate today just as you did before February 9th. Make sure that the physician's documentation corroborates yours, as the DME MACs will continue to analyze claims the same way they did before February 9th until CMS weighs in. Ossur R&R has already passed this information on to the O&P Alliance for consideration and future action. We will keep you posted as events continue to develop.

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