Friday, May 20, 2022

RAC Audits and legislation

Jim DeWees

Hello Everyone, Last week I forwarded on the email about some legislation that was being introduced that took action over RAC audits and has some limitations on these audits. I explained that I had not had time to read any of the bill or investigate it, but just wanted to pass it along.
I still have not had time to really investigate it, but have been told by several other members of this group that this bill ONLY pertains to Medicare Part A issues, and does NOT have any impact or anything to do with O&P. Also, you can go and find a website from the government that gives the “odds” or the “chances” of a bill for passing through the Senate. This bill has less than a 10% chance of being passed anyway. So, sorry to get anyone’s hopes up, or to pass this along and get anyone excited over this. But from what I understand now is that this legislation has NO potential of passing or making any difference in our lives and our businesses. If anyone has any explanation of why this bill was sent out to the O&P world, please share with us, and tell us how this affects us or impacts our situation with RAC audits. On another note, our Region is having a “Webinar” teleconference in 2 weeks. I signed up for it today, it is specifially aimed at “Lower Limb Prosthetics”, and so I feel this is very critical that I participate. I have no idea what they are going to share with us, or what the discussion will be about. But, while signing up, there were a few questions that I was required to answer. I wish I would have written them down now, but they were interesting questions. One of them was something like this: “The prosthetist has the responsibility of evaluating the amputee and deciding the functional level of the amputee”…..and “The documentation from the prosthetist is sufficient to determine the medical necessity of a prosthetic leg”. There were about 5-6 questions like that which I had to answer when I registered. The webinar says it will be a presentation for the first part, and then it will open up to questions from the audience. SO, I am hoping to get a chance to ask them what the correct answer is to these questions. For example, in the Medicare guidebook and policies, it clearly states that the prosthetist is responsible for evaluating the amputee and determining the K level of function for the patient. And, it clearly states that the prosthetist will determine the most appropriate device for the amputee. BUT these RAC audits are asking for medical documentation from the treating physicians, and this is REQUIRED to have in the patient file at the physician’s office. If this is NOT in the patient file at the physician’s office, then it is considered fraud. BUT I cannot find the section in the official Medicare Policies where it requires the physician to document this information. Anyway, I hope that others take advantage of these webinars and ask these questions from the presentors, and see what they can tell us about the official policies and how these RAC audits do not seem to follow their own rules. Thanks, Jim DeWees, CP

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