O&P bill tackles accreditation, audit issues

Friday, March 27, 2015

WASHINGTON – Lawmakers in the House of Representatives and Senate introduced bills last week that seek to apply accreditation and licensure requirements to O&P providers who bill Medicare.

About one-third of O&P providers aren’t accredited, says Tom Fise, executive director of the American Orthotics and Prosthetics Association, which supports the bills.

“Having bills introduced by members of both the House Ways and Means and the Senate Finance committees is a good marker, in my mind (of the strength of our arguments),” he said.

The Medicare Orthotics and Prosthetics Improvement Act of 2015 was introduced March 23 in the Senate (S. 829) by Sens. Chuck Grassley, R-Iowa, and Mark Warner, D-Va., and in the House (H.R. 1530) by Reps. Glenn Thompson, R-Pa., and Mike Thompson, D-Calif. 

Both bills would also define “minimal self-adjustment” as adjustments made to off-the-shelf orthotics by the patient only. 

“This will allow us to get away from the confusion CMS created about caretakers and suppliers and other people being able to (make these adjustments),” said Fise.

In September 2013, CMS released a list of products it considers off-the-shelf, but for some of those products, it assigned two codes: one for when they’re off-the-shelf, and one for when they’re custom fitted.

The House bill also seeks to make several improvements to Medicare’s audit program, including recognizing the notes of O&P professionals as part of the medical record; and preventing CMS from collecting more than 50% of the recoupment amount before an administrative law judge hearing can be held.

That latter would alleviate cash-flow problems for providers, as well as large interest payments that the government must pay back when providers win on appeal.

“About 33% of all recovery audit contractor clawbacks is consumed by interest payments,” said Fise. “What makes more sense than keeping providers from having to dole out money for years, and saving the government money at the same time?”

AOPA on March 20 announced the results of a study it had commissioned that found CMS could save an estimated $12.4 million in interest payments for all Part B services over 10 years.

The audit-related provisions are also included in a larger audit reform bill, also introduced March 23, by Rep. Mark Meadows, R-N.C.

“These are not just O&P issues, or even just Part B issues,” said Fise. “It’s everybody.”