The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) released a webcast wherein NAAOP General Counsel Peter Thomas, JD, discussed the Centers for Medicare & Medicaid Services’ (CMS’) temporary halt of Recovery Audit Contractor (RAC) audits and provided an update on the Injured and Amputee Veterans Bill of Rights, House Resolution (H.R.) 3408.
Temporary Halt of RAC Audits
According to NAAOP General Counsel Peter Thomas, JD, 111 Congressmembers recently signed a letter to U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius raising major concerns with the RAC program and asking her to reign in abuses by these financially incentivized Medicare contractors. Although the letter brought up concerns raised primarily by hospitals, it had the intended effect on all provider audits, including O&P audits. On February 18, CMS announced a temporary stop or pause to RAC audits as CMS enters into a procurement process for the next round of Recovery Audit program contracts, which should take several months. The schedule for the temporary halt follows:
- February 21: The last day a RAC may send postpayment Additional Documentation Requests (ADRs).
- February 28: The last day a Medicare Administrative Contractor (MAC) may send prepayment ADRs under the RAC demonstration.
- June 1: The last day a RAC may send improper payment files to the MACs for adjustment.
Additional changes on the newly selected RACs will also apply, but none of these changes will relieve the physician documentation burdens of the current Medicare program or the lengthy delays in the Medicare administrative appeals process of between two and four years. New Recovery Auditors will be required to do the following:
- Wait 30 days to allow for a discussion with a provider or supplier before sending the claim to the MAC for adjustment.
- Confirm with providers receipt of a discussion request within three days.
- Wait until after the second level of appeal before they receive their contingency fee.
- Implement new CMS-developed ADR limits that will be diversified across different claim types (e.g., inpatient, outpatient).
- Adjust the ADR limits in accordance with a provider’s denial rate.
NAAOP said it is working with the O&P Alliance on RAC legislation to help level the playing field, which will be released soon.
Update on H.R. 3408
H.R. 3408 is bipartisan legislation introduced by Representatives Renee Ellmers (R-NC), Julia Brownley (D-CA), Phil Roe (R-TN), and Raul Ruiz (D-CA), in October 2013. The bill is gaining momentum with 32 cosponsors on the bill at present (26 Republicans and six Democrats). This bill seeks to post in every Veterans Affairs (VA) O&P clinic and on the VA website a list of rights to quality O&P care. These rights will inform veterans of what they can expect from the VA and will serve to empower every veteran to be his or her own best advocate and to obtain the O&P care he or she needs and deserves, consistently throughout the country.
An identical bill passed the U.S. House of Representatives in 2010, but the Senate did not act. At the time, the Congressional Billing Office scored the bill as not costing anything, which is a good sign for eventual passage. Numerous Veterans Service Organizations support the bill and NAAOP said it encourages other members of the O&P profession to support the bill by contacting their Congressmember and asking him or her to cosponsor the bill.