Wednesday, February 8, 2023
OANDP-L
  • Login
No Result
View All Result
The O&P EDGE
  • PECOS
  • Magazine
    • Subscription
    • Current Issue
    • Issue Archive
    • News Archive
    • Product & Service Directory
    • Advertising Information
  • O&P Jobs
    • Find a Job
    • Post a Job
  • EDGE Advantage
  • O&P Facilities
  • Resources
    • Product & Service Directory
    • Calendar
    • Contact
    • About Us
    • O&P Library
    • The Guide
    • Custom Publications
    • Advertising Information
    • EDGE Direct
    • Amplitude Media Group
  • PECOS
  • Magazine
    • Subscription
    • Current Issue
    • Issue Archive
    • News Archive
    • Product & Service Directory
    • Advertising Information
  • O&P Jobs
    • Find a Job
    • Post a Job
  • EDGE Advantage
  • O&P Facilities
  • Resources
    • Product & Service Directory
    • Calendar
    • Contact
    • About Us
    • O&P Library
    • The Guide
    • Custom Publications
    • Advertising Information
    • EDGE Direct
    • Amplitude Media Group
No Result
View All Result
The O&P EDGE Magazine
No Result
View All Result
Home News

Study Shows CMS Could Save Money by Changing Recoupment Process of RAC Audit Appeals

by The O&P EDGE
March 19, 2015
in News
0
SHARES
4
VIEWS
Share on FacebookShare on Twitter

A new report commissioned by the American Orthotic & Prosthetic Association (AOPA) shows that the Centers for Medicare & Medicaid Services (CMS) could save more than $10 million by taking specific steps until the backlog of Administrative Law Judge (ALJ) hearings is resolved. The ALJ hearing is the third of four levels of appeal offered by the Recovery Audit Contractor (RAC) audit program.

The report “Estimated Impact of Deferring Provider Payment for RAC Appeals Until After Administrative Law Judge (ALJ) (Level 3) Determinations,” was completed by Dobson Davanzo & Associates, Vienna, Virginia, and can be found on the AOPA website. According to the report, testimony from Nancy Griswold, chief ALJ, estimated that in July 2013, the Office of Medicare Hearings and Appeals’ (OMHA) Central Operations Division received 15,000 ALJ hearing requests per week. Further, the handling of the appeals has been delayed from the 90 days required by law to three years or longer. As the RAC program currently stands, in order for a RAC claim to enter the ALJ-appeal process, the provider must first reimburse CMS for the payments in dispute. If the ALJ hearing rules in the provider’s favor (fully or partially favorable disposition), CMS becomes responsible for reimbursing the provider for the submitted payment plus interest at above-market rates for the time period between provider repayment and the ALJ determination.

According to the analysis from Dobson DaVanzo, by postponing reimbursement of disputed payments until the disputes are resolved, CMS would not recoup payments from providers for possible overpayments until the ALJ disposition is determined. This would eliminate the need for CMS to make interest payments, estimated to be $7.57 million for O&P services over ten years, or $12.37 million for all of Part B services in the appeal system (including those yet to be recognized by OMHA). Furthermore, providers with successful appeals would not have their resources withheld by CMS for upward of 30 months before they received their repayments.

AOPA said that it is formulating a legislative policy that would delay the recoupment date for RAC audits until after the ALJ hearing and determination. Under this policy, CMS would not hold providers’ payments while the ALJ hearing is in process, and therefore, CMS would not accrue interest to be paid to providers with favorable (or partially favorable) determinations.

Related posts:

  1. The RACs Are Coming: Preparing for Medicare Claims Denials of O&P Care
  2. CMS’ Annual RAC Update at Odds with Reality for O&P Community
  3. Changes Proposed to Medicare Appeals Process
  4. HHS Delays ALJ Hearing Scheduling by Two Years: Continues to Fail to Adhere to Its Own Regulations
Previous Post

Made in Italy: Bionic Leg Unveiled

Next Post

PROTEOR to Host Tour of Beaune

Next Post

PROTEOR to Host Tour of Beaune

  • VIEW CURRENT ISSUE
  • SUBSCRIBE FOR FREE

RECENT NEWS

News

AFOs Improve Stride Length, Gait Velocity, Not Motor Function in Mild CP

by The O&P EDGE
January 30, 2023

Researchers conducted a 20-year retrospective study examining if there were clinically significant changes in gross motor function with the use...

Read more

Mobility Ideal Health Care Acquires Green P&O

Hanger Recognizes 2022 Partner Award Recipients

Pedors Launches Directory of Allied Foot Healthcare Professionals

Get unlimited access!

Join EDGE ADVANTAGE and unlock The O&P EDGE's vast library of archived content.
SUBSCRIBE TODAY

O&P JOBS

Multiple Locations

Join us and experience the freedom to care

Central

Great opportunity for an experienced CPO to join our dynamic team!

Eastern

CPO/CO/BOCPO and Orthotic Fitter

 

© 2021 The O&P EDGE

  • About
  • Advertise
  • Contact
  • EDGE Advantage
  • OANDP-L
  • Subscribe

CONTACT US

866-613-0257

[email protected]

201 E. 4th St
Loveland, CO 80537

The most important industry news and events delivered directly to your inbox every week.

No Result
View All Result
  • PECOS
  • MAGAZINE
    • SUBSCRIBE
    • CURRENT ISSUE
    • ISSUE ARCHIVE
    • NEWS ARCHIVE
    • PRODUCTS & SERVICES DIRECTORY
    • ADVERTISING INFORMATION
  • O&P JOBS
    • FIND A JOB
    • POST A JOB
  • EDGE ADVANTAGE
  • FACILITES
  • RESOURCES
    • PRODUCTS & SERVICES DIRECTORY
    • CALENDAR
    • CONTACT
    • ABOUT US
    • O&P LIBRARY
    • THE GUIDE
    • CUSTOM PUBLICATIONS
    • ADVERTISING
    • EDGE DIRECT
    • AMPLITUDE
  • OANDP-L
  • LOGIN

© 2021The O&P EDGE

Welcome Back!

Login to your account below

Forgotten Password?

Retrieve your password

Please enter your username or email address to reset your password.

Log In
The O&P EDGE Magazine
 
Required 'Candidate' login to applying this job. Click here to logout And try again
 

Login to your account

  • Forgot Password? | Sign Up

Reset Password

  • Already have an account? Login

Enter the username or e-mail you used in your profile. A password reset link will be sent to you by email.

Signup to your Account

  • By clicking checkbox, you agree to our Terms and Conditions and Privacy Policy

    Already have an account? Login

Close
Are you sure want to unlock this post?
Unlock left : 0
Are you sure want to cancel subscription?
 

Account Activation

Before you can login, you must activate your account with the code sent to your email address. If you did not receive this email, please check your junk/spam folder. Click here to resend the activation email. If you entered an incorrect email address, you will need to re-register with the correct email address.