The National Association for the Advancement of Orthotics & Prosthetics (NAAOP) has issued the following statement regarding competitive bidding and the recent OIG report about questionable billing by suppliers of lower-limb prostheses:
Two major developments occurred in August that impact Medicare orthotic and prosthetic services. The first involves the Centers for Medicare & Medicaid Services (CMS) decision not to include off-the-shelf orthotics in Round 2 of the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program. CMS had been contemplating for several months the inclusion of off-the-shelf orthotics, and there were indications that CMS intended to interpret the term “off-the-shelf orthotics” very broadly. NAAOP, in concert with other major O&P organizations, met with CMS on several occasions throughout the summer to advocate for a total exemption of all orthotics and prosthetics from Round 2 of the program. In the alternative, if CMS intended to press forward with inclusion of off-the-shelf orthotics, we advocated that CMS should only do so in a manner that would not compromise patient care.
In mid-August, CMS announced that it would focus on other, more commodity-based, durable medical equipment (DME) for expansion of the competitive bidding program to 91 additional cities across the country over the next several years. This is a very positive development and indicates CMS’ recognition that the provision of O&P care is separate and distinct from DME and is far more complex than DME to competitively bid without risking quality care. However, CMS’ decision on off-the-shelf orthotics does not mean this issue is laid to rest. There may be future opportunities for CMS to pursue competitive bidding of off-the-shelf orthotics, and that means the O&P profession must be vigilant on this issue.
In fact, there are other reasonable and appropriate regulations that CMS could pursue that would be far more appropriate for O&P care. The O&P Alliance organizations, including NAAOP, have been working for several years to link the right to receive Medicare payment with the complexity of O&P care and provider and supplier qualifications to provide those levels of care. For instance, as part of this approach, CMS should fully recognize state O&P licensure laws by prohibiting Medicare payment for unlicensed practitioners in O&P licensure states.
The need for this type of regulation was recently highlighted by the issuance of a Department of Health & Human Services (HHS) Office of Inspector General (OIG) report titled “Questionable Billing by Suppliers of Lower Limb Prostheses” (OEI-02-10-00170). In this report, an OIG audit uncovered significant anomalies with respect to Medicare claims for lower-limb prosthetic devices and offered a series of recommendations to CMS to improve program integrity. One of these recommendations-which CMS is considering implementing-would require a face-to-face physician office visit associated with any claim for a lower-limb prosthesis. Unfortunately, a face-to-face physician visit is a DME-based solution that has been implemented on certain wheelchair prescriptions as well. NAAOP and the O&P Alliance organizations have been advocating for a more O&P-targeted approach.
The major failing of the OIG report is that they did not analyze who supplied the lower-limb prostheses analyzed in the report and whether these suppliers were qualified to provide quality prosthetic care. NAAOP, working through the O&P Alliance, recently responded on this point to the OIG and CMS, and again made the case for O&P-specific solutions to O&P challenges.
NAAOP will continue to keep its members and friends informed of developments as they occur. For more information, visit www.naaop.org or e-mail [email protected]. Access NAAOP’s Congressional Legislative Action Center at www.naaop.org to communicate with your congressman or senator.
