On January 27, the American Orthotic & Prosthetic Association (AOPA) wrote a letter to Marilyn Tavenner, the administrator of the Centers for Medicare & Medicaid Services (CMS) that expressed its concern over the two-year suspension of Administrative Law Judge (ALJ) hearings. Orthotic & Prosthetic Group of America (OPGA), Waterloo, Iowa, and the American Hospital Association (AHA) took independent actions regarding this same issue earlier in the month.
AOPA told Tavenner that due to the financial effects of the Medicare audits, about 100 O&P practices have been put out of business, and patients have been affected as they lost the benefit of their longstanding clinical relationships. AOPA further wrote that this backlog in appeals puts additional financial pressure on providers, many of which are small businesses that cannot afford to have funds “endlessly held up in the appeals process.”
Citing the Medicare, Medicaid, and State Children’s Health Insurance Program Benefits Improvement and Protection Act of 2000 (BIPA), which included a statutory requirement that ALJs issue decisions no more than 90 days from the date the appeal request was filed, AOPA wrote that the statutory and due process rights of O&P providers have been infringed. In view of this, AOPA has called for the suspension of all audits until ALJ hearings are available within 90 days to conform to the law.
The Office of Medicare Hearings and Appeals is hosting a forum on February 12 to discuss the status of its operations and the suspension of hearings.