The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) released its latest webcast in which Peter Thomas, JD, discussed prior authorizations, competitive bidding, and a plan to promote passage of O&P legislation with a virtual congressional fly-in.
Prior authorization of six lower-limb prosthetic Healthcare Common Procedure Coding System (HCPCS) codes will be implemented nationwide on December 1.
By all accounts, Thomas said, the program has been more successful than expected, with relatively quick prior authorization approval times. He suggested that practitioners who experience problems with the rollout report their experiences to NAAOP and ask their affected patients to call Medicare to lodge a complaint.
Despite requests to delay implementation of competitive bidding for certain off-the-shelf (OTS) orthotics in 127 competitive bidding areas (CBAs) throughout the United States, on January 1, 2021, the Centers for Medicare & Medicaid Services (CMS) is rolling out the program, which applies to 23 HCPCS codes. The program has achieved, on average, 30 to 35 percent reductions in reimbursement amounts, varying by geography.
According to Medicare data, Thomas said, certified and/or licensed orthotists provide less than 20 percent of these orthoses, with physicians, therapists, durable medical equipment suppliers and pharmacies providing the bulk of the orthoses. Claims submitted for the OTS codes will not be paid if the supplier does not have a competitive bidding contract.
NAAOP is hosting a pilot virtual Congressional Fly-In to promote passage of O&P legislation, including the Medicare O&P Patient-Centered Care Act (S. 4503) and the Triple A Study Act (S. 4343). The fly-in will test the effectiveness of a virtual model as Congressional members and staff adapt to advocacy during a pandemic. Over 20 board members, NAAOP fellows, and key NAAOP members will participate in over 50 telephonic meetings on December 8. NAAOP will assess the effectiveness of this model and decide whether to host these fly-ins in the future.