05/05/2022    Paul Kesselman, DPM

Urgent Care Center and Walker Boot Braces and DME Items (From Name Withheld)

The provider posing this question offers a very
valid question. In states where there are no
licensure requirements for dispensing orthotics
and prosthetics (the vast majority),
there are no regulations which restrict who can
fit and dispense OTC, custom fit or even custom
fabricated orthotics and/or prosthetics. Only
approximately 17 states have restrictions
requiring licensure regarding the provision of
orthotics and prosthetics. Medicare goes further
in requiring Facility Accreditation and Surety
Bonding for providers who are both not providing
devices to their own patients and who do not meet
the exemption requirements.

That being said, I advise my clients to do what I
did when in private practice, whether it was for a
foot orthotic or AFO, to go back to the original
dispensing provider in order to obtain a properly
fitted device. Should that fail, I would advise
the patient to return the device and contact
Medicare at the 1800 MEDICARE number and let
Medicare know the device did not fit and was
returned. This needs to be done within the return
policy which is mandated to be on the proof of
delivery form or warranty form (as per NSC
requirements). Similar protocols for MCR Advantage
Plans and third party plans should be followed. I
would not recommend adjusting someone else's work
because that could quickly become your nightmare.

In the end you want to satisfy your patients, but
they must be properly educated on the Medicare
regulations and they must take responsibility for
this by signing an ABN and paying you for your
DMEPOS and fitting is more than appropriate. You
can advise the patient you will file a first level
appeal for them as part of your commitment to
getting them to heal.


Should your patient taking the initiative with
dealing with the urgent care center directly fail,
there are multiple factors to consider, with a
multiplicity of providers at the center who fit
patients being one of many. Who at the urgent
center needs education needs to be identified and
that most certainly is for them not you to
identify. You also don't know what the patient(s)
may have refused to accept delivery on nor what
alternative choices the urgent care center may
have offered the patient.

There is also a delicate balance between getting
the patient initially fit correctly without you
upsetting a potential future referral source.
while you don't want to see patients get hurt and
you don't want to cut off a potential referral
source by being abrupt and rude. So handling this
the proper way by education and not being
adversarial is the way to pursue this. Should your
efforts prove fruitless, your patients could
always file a complaint with Medicare and provide
evidence of your charting that the device was not
properly fit. Taking photos in this instance is
recommended.

If you are in one of the states which requires
licensure to fit and dispense AFOs, such as Cam
Walkers, the likelihood is that the urgent care
center may be exempt from that rule because their
staff is comprised of licensed health care
providers (MD/DO/DPM, PA/NP, etc.).

Ultimately the urgent care center may not take too
kindly to your efforts to educate, but if handled
correctly, you may obtain
a referral source which more than offsets the
issues you present.

Paul Kesselman, DPM, Oceanside, NY

There are no more messages in this thread.