Keep Riding the Wave!

By Noori Butt, Technical Medical Specialist, Reimbursement and Coding Policy Department

A famous shark attack survivor once said, “I’ve learned life is a lot like surfing. When you get caught in the impact zone, you need to get right back up, because you never know what’s over the next wave… and if you have faith, anything is possible, anything at all.” – Bethany Hamilton

Bethany is an amputee who has proven time and time again that with a solid support system, motivation, and grit that anything can be possible. You may have seen her story in the movie, Soul Surfer (2011) 1, that highlights Hamilton’s 2003 shark attack survival and her ultimate return to a victorious professional surfing career.

Stories like Bethany’s really hit home. At BWC, the Reimbursement and Coding Policy Department works with injured worker amputees to ensure they receive quality care and services. We collaborate with managed care organizations (MCOs), prosthetic vendors and BWC staff to work toward an efficient, timely, and simplistic process for delivering prosthetic services to Ohio’s injured workers.

This collaboration has resulted in the creation of the BWC Prosthetics Workgroup. This group is tasked with the responsibility to assist in developing standards for the billing and reimbursement of prosthetic devices. Our goal is to use the standardization to create a more efficient and cost effective approach to purchasing high-end, computerized prosthetics. We hope to reduce the overall lag time from physician prescription to the time the injured worker receives his or her fitted, programmed prosthesis. Our workgroup members have gained valuable insight into the prosthetics and orthotics industry as a whole, as well as an appreciation of relevant BWC polices.

In addition to the workgroup, Medical Services recently published a Prosthetic Policy Alert. The alert was published in an effort to assist MCOs with inconsistencies related to the new Prosthetic Pricing Methodology that was implemented in the beginning of 2016. BWC worked to collect input from both MCOs and prosthetic vendors to
include in the alert. The Prosthetic Alert provides details to clarify procedures involved in dispensing of devices in an efficient and consistent manner.

We remain positive as we continue our efforts of further improving prosthetic and orthotic protocols and procedures to best serve Ohio’s injured workers.

As Hamilton enthusiastically implied in her quote – just keep riding the wave!


1
McNamara, S. (Director). (2011) Soul Surfer [film]. Hawaii, USA: Island Film Group.

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