The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) released a new webcast about the increasing pressure by Medicare providers for Congress and the U.S. Department of Health and Human Services (HHS) to enact Medicare audit reform. NAAOP General Counsel Peter Thomas, JD, said if either legislative or regulatory improvements were to be made, a more streamlined, even-handed system could reduce the financial and administrative burden the current system places on O&P and other providers and suppliers.
Referring to the HHS Office of Medicare Hearings and Appeals (OMHA) decision to temporarily suspend the processing of any new Administrative Law Judge (ALJ) hearings, Thomas said that as part of the latest omnibus spending bill, Congress attached directives to HHS related to audit improvements, and the Office of Inspector General (OIG) was instructed to provide the Centers for Medicare & Medicaid Services (CMS) with 25 recommendations to streamline and improve the RAC audit system. NAAOP and the other members of the O&P Alliance will participate in a meeting with OMHA on February 12 to discuss the delays in ALJ appeals.
The O&P Alliance is drafting legislation for improvements to the audit and appeals system to recognize O&P clinicians’ records as part of the medical record to demonstrate medical necessity, further separate durable medical equipment (DME) from O&P, delay recoupment of Medicare funds until the ALJ decision is made, stop audits until OMHA complies with the federal law that requires ALJ decisions within 90 days from the date a hearing request is filed, and establish financial penalties for RACs that have high rates of reversals of denied claims. Thomas said NAAOP will make the legislation available once it is complete.