Getting audited? Speak up

Friday, February 1, 2013

WATERLOO, Iowa – Like so many other segments of the HME industry, orthotists and prosthetists are getting hammered by audits.

“It’s happening all across the country by hired guns, if you will, that are administering policy with so little oversight,” said Dennis Clark, president of the Orthotics and Prosthetics Group of America (OPGA), a division of the VGM Group.

OPGA recently launched, an initiative to collect either written or video testimony from independent O&P providers on the impact that audits have on patient care. OPGA will then contact that provider’s elected officials and their staffers to share those stories.

The videos are especially compelling. So far, 15 videos have been uploaded to the site and there are commitments from other providers, Clark said.

“It’s one thing to write it down, it’s another to see the emotion and passion,” he said. “And it’s so easy to do. Just take a smartphone, shoot it, upload it and boom.”

Ever since a 2011 report from the Office of Inspector General (OIG) stated that Medicare in 2009 made $104 million in improper payments for prostheses that didn't meet certain requirements, providers have seen an uptick in audits, especially in the last six months, says Ryan Ball, director of government relations for OPGA.Claims are often being denied for technical reasons, such as an “illegible” signature. Adding insult to injury, the auditors are going back up to five years and are applying recoupments against new claims, even before they have proved that the provider was in error, he says.

“The small independent guy can’t withstand that type of cash flow pressure,” Ball said.“It’s getting to the point where there are facilities that are questioning whether they’ll be able to continue to treat Medicare patients.”

While the impact to providers is obvious, the impact on patients, ultimately, should prove hard to ignore, Ball says.

“Our patients, particularly amputees, are people that lawmakers and CMS are not likely to turn a blind eye to.” he said.