In a webcast released by the National Association for the Advancement of Orthotics and Prosthetics, Peter W. Thomas, JD, general counsel for NAAOP, discussed the latest proposed rule published by the Centers for Medicare & Medicaid, the Physician Fee Schedule Rule.
The proposed rule would require a face-to-face physician meeting before any durable medical equipment can be provided to a Medicare beneficiary. However, Thomas added that Medicare has exempted O&P from this rule, saying that it will not implement the face-to-face meeting requirement on O&P devices.
Thomas then discussed the problems that are arising from the physician documentation requirements being enforced by Medicare recovery audit contractors, saying that they are having a material effect on claims, denial rates, overpayment requests and the types of devices and component parts that are available to Medicare beneficiaries.
Thomas also discussed a follow-up audit conducted by the DME Medicare administrative contractor in Region A. The original audit found that 90% of lower-limb prosthetic claims from Medicare patients were overpayments, claiming that physician documents were not specific enough about the care that was provided to the beneficiary. Although the follow-up audit claimed a 75% overpayment, Thomas emphasized that this number was still too high.
“This is obviously a problem, and it continues to be a problem,” he said in the statement. “It is something your Washington organizations, including NAAOP, are working very hard to try to get turned around so we figure out how to make sure O&P practitioners get paid for the care that they provide for beneficiaries and that beneficiaries have access to the types of technologies that are going to be most functional for them and meet their needs.”