O&P ALERT: Orthotic Probe Audits Continue In Region C

O&P ALERT: Orthotic Probe Audits Continue In Region C

Kathy Dodson

3/18/2002

O&P ALERT: Orthotic Probe Audits Continue In Region C
As originally reported in the February 5th AOPA In Advance
( <URL Redacted>
< <URL Redacted>> ), the DMERC
put edits in its computer system in December 2001 to automatically select
for audit the first 250 prosthetic claims for certain L codes. The DMERC
suspended the first 250 prosthetic claims with these codes while it
requested medical necessity documentation, including physician's notes. It
also put in edits on a number of orthotic codes, to suspend all claims
having the designated codes until further notice.
Contrary to recent reports, AOPA has today verified in ongoing conversations
with Region C DMERC Medical Review staff that the orthotic probe audit is
continuing. The prosthetic audit, however, has gathered enough claims and no
more new prosthetic claims are being pulled from processing to audit. This
means that you should not see any more delay or routine audit letters for
prosthetic claims, but you will continue to be asked for medical necessity
documentation on claims containing the over a dozen orthotic L codes listed
in the March 5th AOPA In Advance (go to:
<URL Redacted>
< http://www.aopanet.org/membersonly/AIA.shtml > ). Region C staff did not
limit the number of claims selected for review or have a specific date when
the orthotic review would be completed.
AOPA is continuing to work on the problem of the DMERC requiring
non-practitioner medical records and will be meeting with CMS staff in the
near future to discuss this issue.
Kathy Dodson
Senior Director of Government Affairs
American Orthotic and Prosthetic Association
<Email Address Redacted> <mailto:<Email Address Redacted>>