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An Inherent Conflict of Interest—ATP Scribing for LCMP

Monday, November 18, 2019 @ 10:11 AM  posted by jbuytaert

Courtesy of Dan Fedor; U S Rehab

Several months ago I wrote an article titled “The ATP Dilemma” regarding an ATP scribing for an LCMP during the wheelchair (specialty) evaluation. At the time of the article, there were pieces of the puzzle where one could conclude that this is an unacceptable practice for several reasons as noted in the article. However, due to the lack of direct confirmation of the information available, some concluded that this practice was acceptable. Therefore, a pointed question was submitted to the DME MACs (both Noridian and CGS) in hopes of obtaining a clear answer regarding this practice. The DME MACs responded to the question with a concise, written answer during the quarterly Medicare Council meeting which was held on Nov. 12 and 13 in Nashville. The answer from Medicare confirms that this practice is not acceptable as there is an inherent conflict of interest since the supplier and LMCP can’t have any financial relationship, and by scribing for the LCMP, this is providing something of value (in kind) which violates the LCD. This can also lead to a possible Anti-Kickback violation.

Here is the exact question submitted to the DME MACs and their joint response:

Q: Is it acceptable for the supplier’s employed ATP to act as a scribe for the LCMP during the specialty evaluation?

DME MAC Response: This is not an acceptable practice. For the LCDs with LCMP evaluation requirements (power mobility devices, manual wheelchairs, wheelchair options/accessories and wheelchair seating), each profession has a separate and distinct role in the process to document the medical necessity of the item to be ordered. Each LCD clearly states the role and function of each professional evaluating the beneficiary. The LCDs specifically indicate that the “licensed certified medical professional,” such as a PT or OT, or a practitioner who has specific training and experience in rehabilitation wheelchair evaluations and that documents the need for the device in the beneficiary’s home. In addition, the LCDs indicate that there should be no financial relationship between the supplier and the LCMP. The ATP is hired by the supplier. If the ATP is scribing for the physical therapist, there is an inherent conflict of interest. Moreover, by serving as a scribe, the ATP makes the therapist more “efficient” by saving time, thus allowing them to see more patients, what is often described as “in kind” assistance. The requester may wish to seek an advisory opinion from the Office of Inspector General (OIG) to confirm.

End of DME MAC Response

Since it is now directly confirmed from all four DME MACs that having the ATP scribe for the LCMP during the specialty evaluation is not an acceptable practice, suppliers must be prepared to help educate LCMPs about the documentation requirements for complex rehab wheelchairs and accessories so they can efficiently prepare a comprehensive specialty evaluation with the necessary content for qualified patients to receive the ordered equipment in a timely manner.

It is a challenge to educate LCMPs on these requirements with consideration of their internal productivity requirements to see patients. However, a small investment of their time will yield ongoing results that will enable them to efficiently and effectively write a detailed specialty evaluation that addresses the LCD requirements. U.S Rehab is here to help with this education with materials, as well as a two-hour CEU course titled, “Documentation LIFE Preserver,” which is geared toward educating the LCMP with key points that must be addressed in their specialty evaluation. Please contact me directly at dan.fedor@vgm.com or 570-499-8459 about more details on offering this course in your area.

Dan Fedor

O: 844-794-8459
C: 570-499-8459
E: dan.fedor@vgm.com

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