Performant Recovery, the Jurisdiction A Medicare Recovery Auditor (RA), has posted a notice that NHIC, the Jurisdiction A Durable Medical Equipment Medicare Administrative Contractor (DME MAC), will conduct a complex review of AFOs because potential incorrect billing occurred when claims for AFOs were billed without an indication supporting medical necessity as described in NHIC’s Local Coverage Determination (LCD) L11527 and related article A19806. Claims having a claim paid date that is more than three years prior to the Additional Documentation Request (ADR) date will be excluded.
The affected L-Codes can be found in the LCD and related article.