Performant Recovery, the Region 5 national Recovery Audit Contractor (RAC) for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), and home health/hospice services, announced that it is initiating a post-payment complex medical claims review for custom-fabricated AFOs and KAFOs. The affected codes are L-1900, L-1904, L-1907, L-1920, L-1940, L-1945, L-1950, L-1960, L-1970, L-1980, L-1990, L-2106, L-2108, L-4631, L-2000, L-2005, L-2010, L-2020, L-2030, L-2034, L-2036, L-2037, L-2038, L-2126, and L-2128. Providers whose claims are selected for review will receive an additional documentation request (ADR) letter requesting documentation to support medical necessity for the provided orthosis. Failure to respond to the ADR will result in automatic claim denial and recovery of any payments previously made.
The audit is its first O&P-specific issue since Performant Recovery was awarded the RAC contract in November 2016 and given approval to begin DMEPOS audit activities in March.
