Action Alert: Urge Medicare to Increase Allowables for New LSO K Codes

Action Alert: Urge Medicare to Increase Allowables for New LSO K Codes

AOPA

7/16/2004

In May 2004, Medicare published new HCPCS K codes for LSOs with
reimbursement rates that were 40-80 percent below 2003 Medicare payment
rates. The new K codes and corresponding reimbursement rates went into
effect on July 1 and seriously threaten access to a wide range of
devices and services, as the reimbursement rates do not adequately
reflect the cost of providing these services to Medicare beneficiaries.

AOPA is currently in discussions with senior CMS officials to seek a
solution with the goal of having these reimbursement rates adequately
reflect the true cost of providing these services to Medicare
beneficiaries. But we still need you to speak out on behalf of your
industry. In addition, AOPA wrote two letters to Medicare raising our
concerns and recommending corrective action. To view these letters,
visit www.aopanet.org and click on Hot Issues in O&P.

TAKE ACTION NOW:
AOPA urges all O&P professionals to immediately contact officials at CMS
and the SADMERC asking that they recalculate the allowables for the new
K codes. You should also request that any changes made to these
reimbursement rates be made retroactive to July 1. Below are points
that should be incorporated in your letter. Remember, letters that
include specific examples and/or personal experience will be viewed more
favorably. Send your letter today.

POINTS TO INCLUDE IN YOUR LETTER:
*Reimbursement rates for certain LSOs are 40-80 percent below 2003
Medicare payment rates. These inadequate reimbursement rates will
undermine the quality of LSO devices delivered to Medicare beneficiaries
as well as limit access to devices.

*Request that CMS and the SADMERC take into consideration all the costs
of providing a device to a patient. Simply using manufacturer wholesale
and retail prices with a generic markup factor does not take into
consideration all the facets of care necessary to provide a device to a
patient. Medicare should contact O&P practitioners in private practice
to determine these costs rather than use manufacturer wholesale or
retail prices with a generic mark up factor.

*Request that CMS and the SADMERC take into consideration the costs of
providing 90 days of follow-up care that is mandated to be included in
Medicare's reimbursement rate.

*Request that CMS and the SADMERC select devices that are representative
of LSOs commonly provided to patients by O&P practitioners. There is
concern that devices that would not be provided by an O&P professional
have been included in the calculation of the Medicare allowables.

*Request that CMS and the SADMERC make any changes to reimbursement
rates for these LSOs retroactive to July 1, 2004.

Letters should be sent to:
Mr. Joel Kaiser
CMS Health Insurance Specialist
Centers for Medicare and Medicaid Services
Mail Stop C5-06-27
7500 Security Blvd.
Baltimore, MD 21244

Copy to:
Ms. Bonnie Brooks
SADMERC
17 Technology Circle
Columbia, SC 29203

Ms. Kathy Dodson
AOPA
330 John Carlyle St., Suite 200
Alexandria, VA 22314
FAX: (571) 431-0899

If you have questions about Medicare legislation or want to get involved
with AOPA efforts in Washington, D.C., contact Kathy Dodson at (571)
431-0876, ext. 210 or Walter Gorski at (571) 431-0876, ext. 209.

AOPA thanks you for your efforts on behalf of the O&P industry. Your
input makes a difference!