Saturday, May 21, 2022

ANNOUNCE: Academy receives RAC AUDIT information correction

Manisha Bhaskar

RAC AUDIT Information Correction

We want to immediately share with you the email the Academy received from CMS regarding recent audit rescissions (included below). Upon inquiry, CMS informed us that the rescission letters to providers in Region A were sent in error. CMS has apologized for any confusion this has caused.

The Academy views this as an unfortunate turn of events and conveyed our displeasure with this decision to CMS. The Academy continues to be deeply concerned about these unjustifiable audit practices. We will continue to work with the O&P Alliance to convince CMS that such legacy audits need to be stopped in the interests of our patients and businesses. Unfortunately, this means that clinicians must continue to respond to CMS audit requests. We also urge you to appeal any audit result that you feel is erroneous.

Should you have any thoughts on this issue or suggestions as to how we might best move forward, don’t hesitate to contact [email protected] We always appreciate hearing from you.

The email received from CMS begins below:
___________________________________________

Good Afternoon Mr. Rosenstein,

This is in response to your e-mail of July 22, 2013 to Marilyn Tavenner concerning Recovery Auditor review of prosthetic claims. You asked if the Centers for Medicare & Medicaid Services (CMS) has decided to change the look back period for Recovery Auditor review of prosthetic claims. The answer is no.

Under CMS regulations 42 CFR 405.980 Medicare review contractors may reopen a claim for any reason within one year and after one year but up to four years if there is good cause. CMS, however, limited Recovery Auditors in their statement of work to a three year look back period. Prosthetic claims reviewed by Recovery Auditors are subject to the three year look back period for Recovery Auditor review. You mention that members of your organization have received letters from Performant, the Region A Recovery Auditor rescinding record requests. These rescission letters were issued incorrectly. However, the Recovery Auditor will not reissue record requests for claims for which it sent letters rescinding the original record request.

CMS did issue direction to the Recovery Auditors to limit review of Power Mobility Device (PMD) claims to the last twelve months. As you may know, CMS is undertaking a demonstration to prior authorize PMDs in seven States. In these seven States, one hundred percent of PMDs subject to the requirement of the demonstration are being reviewed. This demonstration started in August 2012. The twelve month look back period makes the Recovery Auditor review of PMD claims in the non-demo States parallel the timeframes of claims reviewed under the demonstration. Our intention was to issue an instruction only with regard to PMDs, and CMS will issue clarification on our website.

Please accept our apologies for any confusion that was caused by the rescinded record requests.

CDR Brian Elza, PT, DPT, OCS
Physical Therapist, United States Public Health Service

Deputy Director, Division of Recovery Audit Operations Provider Compliance Group/OFM Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244

Manisha S. Bhaskar
Director of Publications & Marketing
American Academy of Orthotists & Prosthetists
1331 H Street, NW, Suite 501
Washington, DC 20005
PHONE (202) 380-3663
FAX (202) 380-3447
WWW.OANDP.ORG

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