The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) has released a new video webcast it has titled “Death by a Thousand Cuts,” in which NAAOP General Counsel Peter Thomas, JD, discusses the Medicare auditing situation and the growing pressure on O&P providers and suppliers. The following statement was issued along with the webcast:
This month alone, the Centers for Medicare & Medicaid Services CMS has proposed a new regulation that would permit CMS to disenroll a Medicare supplier if it has a pattern of high error rates in Medicare audits, even if the denied claims are being appealed. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a report on surety bonds that has already prompted some contractors to begin collecting on surety bonds even in instances where Medicare regulations prohibit this from occurring. And CMS issued a transmittal allowing CMS to deny enrollment applications of O&P and other providers and suppliers when an overpayment exists, even though that overpayment is in the administrative appeals process.
NAAOP, in conjunction with the O&P Alliance, is responding to each of these new developments and actively pushing back, but given CMS’ lack of response on the physician documentation problems to date, the outcome of our advocacy is difficult to predict. Protecting the Medicare program from fraud and abuse is good politics, but the fact that these efforts are ensnaring legitimate providers in all settings, including O&P, is beginning to take hold.
But hope is on the horizon. The Senate Finance Committee recently held a hearing on Recovery Audit Contractors (RACs), and, to the surprise of many observers, all but one senator expressed concern that perhaps the RACs’ financial incentives are so lucrative that RACs are ultimately denying legitimate claims in order to make a profit. A recent OIG report found that 60 percent of RAC denials are overturned at the Administrative Law Judge (ALJ) appeal level, a figure that many senators on the Finance Committee found very alarming.
In fact, Senator Hatch (R-UT), the ranking Republican on the Finance Committee, stated, “Such a high rate of reversal raises questions as to whether RACs are being too aggressive or do not understand current medical practice.” Raising awareness of overzealous Medicare contractors is a necessary ingredient to getting Congress to act to rein them in.
NAAOP will continue to track these developments and advocate for protections for O&P professionals, providers, and suppliers. The webcast is posted on the NAAOP website, shared with members via e-mail, and made available through the NAAOP page on Facebook.