Thursday, May 26, 2022

Denial of Orthotic Care in SNF Setting-AOPA Requests

AOPA

Dear Listserv Members:

A senior lawmaker on the Ways and Means Committee has asked AOPA to
collect specific examples where Medicare Skilled Nursing Facilities
(SNFs) are denying prescribed orthotic services to their patients. AOPA
was told that if we can make a compelling case that covered orthotic
services are not being provided to Medicare beneficiaries, AOPA may be
able to have orthotic services excluded from the Medicare SNF
prospective payment system. If we are successful in convincing
lawmakers to make this change, practitioners would be able to bill the
DMERC directly rather than look to the SNF for payment–as is the
current policy for prosthetic services.

AOPA has posted several requests for this type of information in the
past. However, in view of this high level congressional request, we are
seeking as many current examples as possible to leave no doubt with
lawmakers that they need to address this problem. We are looking for
any and all types of examples such as SNF’s substituting a lesser
quality/priced device than the one prescribed, denial of a purchase
order for prescribed orthotic devices, SNF requests to alter delivery
dates until the patient has left the SNF, or any other billing
irregularity, etc.

We recognize that there is always some hesitancy to share examples out
of concern of harming a relationship with a business partner or referral
source. To protect your privacy, we will not use your facility’s name
or the name of the SNF in our examples to our lawmakers. Our focused
goal is simply to show that this issue remains a serious and ongoing
problem that can only be fixed through legislation.

If you would like to share an example of a SNF denying prescribed
coverage of orthotic services, Please contact AOPA’s Walt Gorski at
[email protected] or (571) 431-0809.

Thank you for your attention to this request.

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