NAAOP discusses pre-payment reviews

The National Association for the Advancement of Orthotics and Prosthetics released a webcast addressing some of the questions received during its all-member webinar on April 17.

One of the issues that was addressed was the Dear Physician letter and resulting recovery audit contractor (RAC) audits. According to Peter W. Thomas, JD, general counsel for the NAAOP, the Centers for Medicare and Medicaid (CMS) recently changed the rule regarding how many claims can be requested from Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) providers. According to the new rule, if a claim is submitted with any of the number 50 codes, then CMS is limited to requesting no more than 10 patient files in a 45-day period, which is down from 250 patient files per 45-day period.

“That’s a major reduction, and it’s something that is very encouraging,” Thomas stated in the webcast. “We don’t know exactly how many O&P practitioners or businesses that it will impact in a meaningful way, but it is certainly a movement in the right direction.”

Thomas also discussed pre-payment review under the RAC program. He said that RACs can only put providers under a pre-payment review under a demonstration program, which does not apply to O&P practitioners. However, Medicare Administrative Contractors (MACs), including DME MACs, have the authority to put practitioners on pre-payment review, but they are supposed to demonstrate that there is a high or sustained error rate.

“If you are put on pre-payment review, and you have never had claims denied and don’t have a high error rate, then you should definitely challenge being put on pre-payment review,” Thomas stated.

But, according to Thomas, pre-payment review can be beneficial because it allows practitioners to perfect claims before they are submitted in order to get reimbursed.

“If you are put on pre-payment review, the best advice is to focus on the documentation and do everything in your power to submit clean claims,” Thomas stated. “And if you can do that, you will be taken off of pre-payment review relatively quickly.”

To watch the entire webcast, visit,

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