OIG report triggers meeting between AOPA, CMS

Thursday, December 8, 2011

WASHINGTON - The American Orthotic & Prosthetic Association (AOPA) wants prosthetists recognized as the allied healthcare professionals they are, rather than as "device dealers."

That's why, last month, AOPA officials met with Peter Budetti, CMS administrator for program integrity, to discuss a number of concerns triggered by an August report from the Office of Inspector General (OIG). The meeting was a good first step, said Joe McTernan, director of coding and reimbursement, education and programming for AOPA, who participated. 

"We'll continue to try to follow up with him and his staff," he said. "We would love to see some recognition that we are not device dealers, and go back to how it has been traditionally-to allow the prosthetist to document the need for clinical care of patients."

The report from the OIG said that Medicare in 2009 made $43 million in improper payments for lower limb prostheses that didn't meet certain requirements, and another $61 million for prostheses with no documentation from referring physicians.

The report doesn't accurately reflect how prosthetic care is provided, McTernan says. Typically, if a patient has something wrong with his prosthesis, he calls the prosthetist, not the physician.

"The prosthetist can do the evaluation, and if there is something that requires referral back to the physician, then the prosthetist is going to suggest the patient go see the physician," he said. "The physician absolutely has to be involved, but there's a reason the physician is referring the patient to the prosthetist."

Since the release of the OIG report, there's been an uptick in audits for lower limb prostheses, said McTernan.

"The DME MACs are recouping monies based solely on the physician documentation," he said. "There can be pages and pages of good quality progress notes in the records of the prosthetist, but they are ignoring that."

AOPA agrees that physicians have the ultimate responsibility for patient care, but the effect of the OIG report was to significantly downplay the role of prosthetists.

"Prosthetists aren't standing behind a counter handing over legs to patients," said McTernan. "There's a certain amount of skill, knowledge and expertise that goes into a proper fit."