oandp.com

From: Thomas L Malone [mailto:[E-mail Address Removed]]
Sent: Friday, September 07, 2012 1:55 PM
To: '[E-mail Address Removed]'
Subject: Custom KO's for Medicare Patients





Hello:



I am wondering if anyone else is getting 100% of their custom Knee braces
denied by Region D Medicare. We keep getting the denial " does not meet
medical necessity per the LCD". We had a 500 LB plus ambulatory patient in
for a knee brace that clearly was outside of the normal off the shelf range,
we took measurements of the thigh and calf, noted everything, had the doctor
note the need for a custom KO and it was still denied as not meeting medical
necessity.



We have picked the LCD apart and tried explaining our reasons for a custom
KO using their exact language and it's still denied.



Is anyone getting their custom KO's paid for by Medicare Region D? If so,
how are you doing it?


Thanks,



Tom Malone, COO

St. Louis