Practice Management
Running an orthotic practice
Practice management questions test the business and operational side of care: documentation standards, billing and coding, insurance and payer requirements, inventory and materials control, scheduling and workflow, staff roles and supervision, safety and infection control, and quality improvement. You should understand that clinical documentation is also a legal and financial record, and that payer rules require documented medical necessity linking the patient's condition to the device.
Key concepts
- Medical necessity documentation: diagnosis, functional deficit, why the device is needed, why this device, expected outcomes.
- Coding and billing integrity: the code must match the device actually provided; upgrades must be documented and justified.
- Inventory control: lot tracking, storage conditions for thermoplastics, and preventing expired or damaged materials from reaching patients.
- Infection control: hand hygiene, equipment cleaning between patients, and safe handling of casting materials.
- Workflow and supervision: knowing which tasks require a licensed clinician versus delegated staff.
Traps to watch
- Billing for a device that differs from what was delivered or documented.
- Assuming a signed physician order alone establishes medical necessity - the clinical record must support it.
- Skipping documentation of patient education or of a device's serial/lot information.
- Overlooking that quality improvement requires tracked data, not anecdotes.
- Ignoring scope-of-practice limits when delegating.
Rule of thumb
If it was not documented, it was not done - and if the documentation does not match the delivered device, it is a compliance problem, not a clerical one.
Worked example
A clinician delivers a prefabricated AFO but bills a custom-fabricated code because "it functions the same." The correct answer is to bill what was delivered; the discrepancy is a billing integrity issue regardless of clinical outcome.