03/12/2018    Paul Kesselman, DPM

Orthotist Hiring (Doug Richie, DPM)

It is impossible to provide one universal
response which applies to all the possible
scenarios posed by this follow-up question. The
first part of the question implies the DPM is
referring the patient to someone in the same
office. Does the referral constitute a "hand off"
to the other person to evaluate and treat that
patient or is the DPM still involved in that
aspect of the treatment?

The second part of the question infers a common
scenario where a DPM has hired the CO or CPO as
an employee and has delegated the CO CPO to
conduct certain tasks. MCR and other carriers
have certain rules regarding supervision of those
tasks which are way beyond the scope of this
short response.

The following is thus admittedly a very short
overview of the two scenarios:

Theoretically the DPM can bill for those services
if he wrote a rx (in the chart) had the CO or CPO
simply do the casting and then the DPM dispensed
the device (or had the CO or CPO dispense it).
But that may only apply if the the relationship
between the DPM and the CO CPO was that of
employer and the payrolled employee receiving a
W2.

State law however, may preclude whether a DPM can
actually hire another licensed professional. And
there are additional considerations which may
apply (see below).

However, if the DPM referred the patient to the
CO or CPO and the CO or CPO does not have set
hours mandated by the DPM and is not on the DPMs
payroll that is a very different scenario. In
this situation, the CO or CPO may actually be
acting independently as a consultant to the DPM.
This may or may not meet the litmus test as the
CO CPO acting as an independent practitioner
(these are IRS regulations). In this scenario the
CO CPO may be required to be independently vetted
by the third party payer, may be required to
maintain his/her own charting and bill the
insurance carrier separately may vary by carrier.

If that is not confusing enough, here are some
other questions which may further confuse the
situation but need addressing prior to coming to
a conclusion:

Who is paying the central fab lab? Who is writing
the fitting, casting and dispensing notes and who
is signing them? Where are the charts located?
Does the DPM and the CO/CPO have separate charts?
Is the CO CPO paying rent to the DPM?

These nuances may further confuse the issue.

The bottom line is that when one is faced with
these complex issues, a health care attorney well
versed in: Anti-Kickback Statutes (this applies
to all carriers not just Medicare), state
licensing issues, IRS and other insurance
regulations should be consulted.

As the circumstances vary, the attorney may wish
to work with a nonsultant well versed in DME
enrollment and provider issues. Answering all
these questions is not always simple and the way
the business frame work is set up may dictate the
proper method by which to chart, pay the vendor,
etc.

Once all the specific circumstances/questions are
addressed, one can then proceed to ask the
various third party payers how to proceed.

Paul Kesselman, DPM, Woodside, NY

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