Please find the link below for our video on this subject matter. Also, see
our written update.
“Death by a thousand cuts.” Video Webcast
(http://www.naaop.org/vid.asp?name=bcast_july-2013.mp4)
Death by a Thousand Cuts
A little dramatic perhaps, but the title of this month’s update seems to
describe the Medicare auditing situation and the growing pressure on
orthotic and prosthetic providers and suppliers. This month alone, CMS has
proposed a new regulation that would permit CMS to disenroll a Medicare
supplier if they have a pattern of high error rates in Medicare audits, even
if the denied claims are being appealed. The HHS Office of Inspector General
issued a report on surety bonds that has already prompted some contractors
to begin collecting on surety bonds even in instances where Medicare
regulations prohibit this from occurring. And CMS issued a Transmittal
allowing CMS to deny enrollment applications of O&P and other providers and
suppliers when an overpayment exists, even though that overpayment is in the
administrative appeals process.
NAAOP, in conjunction with the O&P Alliance, is responding to each of these
new developments and actively pushing back, but given CMS’s lack of response
on the physician documentation problems to date, the outcome of our advocacy
is difficult to predict. Protecting the Medicare program from fraud and
abuse is good politics, but the fact that these efforts are ensnaring
legitimate providers in all settings, including O&P, is beginning to take
hold.
But hope is on the horizon. The Senate Finance Committee recently held a
hearing on Recovery Audit Contractors and, to the surprise of many
observers, all but one Senator expressed concern that perhaps the RACs
financial incentives are so lucrative that RACs are ultimately denying
legitimate claims in order to make a profit. A recent OIG report found that
60% of RAC denials are overturned at the ALJ level of review, a figure that
many Senators on the Finance Committee found very alarming.
In fact, Senator Hatch, the ranking Republican on the Finance Committee,
stated, “Such a high rate of reversal raises questions as to whether RACs
are being too aggressive or do not understand current medical practice.”
Raising awareness of overzealous Medicare contractors is a necessary
ingredient to getting Congress to act to reign them in.
NAAOP will continue to track these developments and advocate for protections
for O&P professionals, providers, and suppliers. Thank you for your support.
Please visit our website at: www.naaop.org
NAAOP
1501 M Street, NW
7th Floor
Washington, DC 20005-1700
e-mail: [email protected]
(800) 622-6740
(202) 624-0064 Phone
(202) 785-1756 Fax
www.naaop.org
