Hello Colleagues and Guests,
The Statement of Work for the Recovery Audit Program can be found as a
link on the oandpsolutions.org website, under Links, and then under RAC.
This is a 57 page document and we are hopeful that some of you will take
the time to read this and report your findings to us. At a quick glance,
page 28, partial denials, seems to be interesting and, we believe, needs
further review. It appears that this document would be worth reading for
your own benefit.
In cases where K3 is the only denial reason for a prosthetic claim, it
seems that partial payments, perhaps, should have been paid by CMS
inasmuch that a lower level prosthetic system would have still been
appropriate regardless of the K3 situation.
Have a good weekend.
Wil Haines, CPO
MaxCare Bionics
Avon, IN
