This article is about the importance of interprofessional communication and report generation in building professional physician relationships, as well as the importance of accurate and complete forms for insurance companies that include all up-to-date requests they require. These relationships will serve to increase the reputation of your practice and increase your referral base.
More insurance companies are now requiring referrals from medical doctors or podiatrists in order for a claim for custom orthotics to be reimbursed. The great majority of these referrals will be from a family physician. Once given a prescription for orthotics, patients have, at this time, a variety of professionals they can choose to dispense their orthotics: chiropractors, physiotherapists certified pedorthists, chiropodist and podiatrists.
It has recently come to my attention that Blue Cross has eliminated chiropractors from the list of professionals who are recognized to dispense orthotics – and that other bodies are not far away from completely removing, from DCs, the ability to dispense orthotics, period. If the chiropractic profession wishes to protect its current ability to dispense orthotics, individual DCs and our association should become active in advocating for this. If we do loose the ability to dispense, the option to maintain this service in your clinic can be performed by hiring a Certified Pedorthist to dispense the orthotics for you – this allows you to make the service available to your patients and still retain a majority of the income stream you have derived dispensing orthotics. However, your data needs to be organized in order for you to do this – then dispensation appointments can be scheduled back-to-back, only requiring the dispensing professional to come to the clinic as needed.
If a referral for orthotics ends up in your office, it is proper etiquette to send the referring doctor a letter to summarize your findings in a concise report. This report serves to let the physician know that the patient has been examined, the results of the examination, the location of the pain, the diagnosis and the type of corrective orthotic device prescribed.
Generating a letter and report with your findings for the referring physician may seem like a lot of work but it can be done with the click of a mouse – if you have the proper orthotic practice management systems in place.
In my practice, proper record keeping involves documenting all of the important findings of the foot and gait examination and the patient’s history as well as the specifics of the orthotic design. I do this during my exam with a simple form, which also serves to guide my examination, and I simply check off and fill in any important information.
Table 1 shows examples of the major things that I record for each patient.
All of the relevant exam information is then imported, by my receptionist or assistant, into my management software, and then I can generate the forms necessary. These are as follows:
|HISTORY||PHYSICAL EXAM||ORTHOTIC DESIGN|
|History of trauma||Pain location and severity||Length|
|Ankle sprains and severity||Pain type||Shell material|
|Congenital anomalies||Gait findings||Shell thickness|
|Disease processes – diabetes||Callus, corn, bunion||Underlay material
|Types of activities||Foot rigidity||Top cover type|
|Orthopedic surgeries||Pronator or supinator||Postings|
|Family history||Shoe wear patterns||Modifications|
This should provide a very clean, easy-to-read summary of the essential findings from the patient’s history and physical exam, including the diagnosis and orthotic design. In my case, it has my practice’s logo on the letterhead, along with the patient’s name and family physician’s name and address; as such, it is ready to be mailed out or can be e-mailed.
If a patient believes that they do not require a medical referral, but after sending all necessary forms to the insurance company, calls back stating that they do, we can also provide the patient with a Physician’s Report, which is a summary sheet of the exam findings, diagnosis and device prescribed. We ask them to take it to their doctor to obtain a referral. When they receive their medical referral, they are then told to send it to their insurance company, which will result in the payment of their claim.
After I have had a few communications of this sort with a particular doctor, I will include a few referring slips in the envelope. Following this easy step, I have received some referrals from these doctors, and have built relationships with them – I have also increased my clinic’s professional presence and credibility within my community.
Insurance companies are becoming increasingly specific in terms of what is required on the forms for them to reimburse the claim. They require the forms to include the casting technique used; the name and location of the lab; the materials used to make the orthotic; the diagnosis and symptoms; clinical examination findings; gait analysis findings; confirmation that the orthotics are custom-made; confirmation that they have been paid in full; and dispensing as well as the cost breakdown. In my clinic, I generate a very detailed and complete form that all insurance companies will accept with the click of a mouse.
When a patient comes in for a re-exam, I print a Re-Exam Summary so that I have all of their relevant exam and orthotic design information in hand. I can immediately access their previous exam findings, pain location, diagnosis and the types of orthotics that they have. They can see I am organized and can easily and accurately complete my exam and new orthotic design.
Generating reports is important and necessary to building a successful orthotic dispensing practice. Having a system to keep all necessary information, and to use this information to generate forms quickly and easily, saves time and increases professionalism.