O&P MythBusters: Common Assumptions Explained

In this episode, host Seth O’Brien, CP, FAAOP(D), sits down with Lesleigh Sisson, CFo, CFm, founder of O&P Insight, for a MythBusters-style conversation about common misconceptions in O&P clinical practice. Together, they unpack several assumptions that can lead providers astray, including the belief that prior authorization guarantees payment and the importance of accurate enrollment and place-of-service billing for multi-office practices. The discussion also covers payer requests for invoices, clarifying what providers are—and are not—required to supply. The episode highlights key compliance considerations, such as why proof of delivery alone is not enough to justify billing, how standard written orders must be supported by current documentation of continued use, and the role CPO notes can play in supplementing physician records. Seth and Lesleigh also explore issues such as diagnosis-code mismatches, replacement rules within a reasonable useful lifetime, prosthesis eligibility when a power wheelchair is present, and circumstances where additional test sockets may be justified with proper documentation.

 

Show Notes

Lower Limb Prosthetic LCD and Policy Article

LCD - Lower Limb Prostheses (L33787)

Article - Lower Limb Prostheses - Policy Article (A52496)

 

Power Mobility Device LCD and Policy Article

LCD - Power Mobility Devices (L33789)

Article - Power Mobility Devices - Policy Article (A52498)

 

Standard Documentation Requirements

Article - Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)

 

Same or Similar Resources

Same or Similar: How to Avoid Denials - JA DME - Noridian

Same or Similar Chart - JA DME - Noridian

 

Making Corrections to Medical Records

Documentation Guidelines for Amended Records - JE Part B - Noridian

 

The Medicare Learning Network

The Medicare Learning Network® | CMS

 

Medical Records Requirements

MLN909160 – Complying with Medical Record Documentation Requirements

MLN4840534_Medical Record Maintenance & Access Requirements

Provider Minute: The Importance of Proper Documentation

MLN905364 – Complying with Medicare Signature Requirements