The provision of prostheses and orthoses to Medicare
beneficiaries has come under heavy fire over the past few years with the imposition of new documentation requirements that were issued without the Centers for Medicare & Medicaid Services (CMS) following proper procedures. This created extensive auditing and shifting medical necessity criteria. The advent of the Recovery Audit Contractor (RAC) program, along with ramped up efforts by benefit integrity contractors such as Zone Program Integrity Contractors (ZPICs), have fueled auditing to reach new heights. Of course, O&P is not the only provider group under attack. Virtually all settings of providers under Medicare are mired in heavy auditing activities.
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