The American Orthotic & Prosthetic Association (AOPA) announced that it testified during the June 6, 2013, U.S. Small Business Administration (SBA) Regulatory Fairness hearing held in Seattle, Washington, during which numerous O&P providers voiced their concerns about the devastating impact the Recovery Audit Contractor (RAC) audits are having on their businesses. The hearing was held by the SBA National Ombudsman, who assists small businesses with unfair and excessive regulatory enforcement by federal agencies including repetitive audits or investigations, excessive fines, penalties, retaliation, or other unfair regulatory enforcement actions.
The following were among the concerns expressed by AOPA and O&P providers:
- The Office of Inspector General (OIG) Report and subsequent Dear Physician letter that has changed the standard of care, often forcing practitioners to choose meeting the patient’s immediate need for a prosthesis by providing a less sophisticated device, rather than endure long delays in care triggered by the paper chase with physicians.
- The lack of consideration given to the prosthetist’s notes by the Centers for Medicare & Medicaid Services (CMS) and CMS’ position that the documents lack validity due to the prosthetist having a financial interest in the claim.
- Entire claims being recouped rather than the line item in question.
- The lengthy appeals process.
- Challenges with finding physicians to prescribe prostheses and to complete the required paperwork.
- Financial challenges to providing componentry upfront and subsequently fighting to get paid when running on a small profit margin.
- Challenges with battling audits and finding time to also care for patients.
- Qualified practitioners leaving the field.
- Employees losing jobs when small businesses close.
- Patient care suffering as a result of these concerns.
- These audits are jeopardizing the economic viability of these critical healthcare providers.
According to AOPA, the call was largely dominated by small businesses concerned with CMS regulatory action. There were also several durable medical equipment (DME) suppliers expressing concern with the impact of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program on their businesses and patients.
The SBA will hold another Regulatory Fairness Hearing on June 21, 2013, in Davenport, Iowa, from 8:30 a.m.-11:30 a.m. CT. AOPA said it plans to participate in this upcoming hearing. For more information on the June 21 hearing, click here.
