Re: OTs and RAC audits
Wil
Description
Collection
Title:
Re: OTs and RAC audits
Creator:
Wil
Date:
12/18/2012
Text:
Good question Jennifer. This issue needs to be presented to the OIG and
should be done in the near future inasmuch that Medicare seems to lend a
deaf ear to O&P logic. It is undoubtedly a double standard that has been
going on for years and if the RAC auditors challenged this issue,
Medicare would likely claw back a lot more money. Furthermore, when
physicians use the LCode system, they too become Suppliers and
temporarily step out of the physician arena. Eventually, some of us may
have to challenge Medicare in court on this issue. A double standard is
a double standard. In the meantime, audits are increasing and the pain
is just beginning on a national basis. Furthermore, in addition to
Medicaid audits, similar audits are being implemented by independent
third party insurance companies. They too see the value in clawing back
money from health care providers.
If you read the new upcoming rules for lower limb orthotics, I think you
will be surprised by what you see. Look at the proximal termination
requirement for an AFO. Obviously, someone in authority at Medicare does
not understand the mechanics of nor the nomenclature of O&P. Then, take
a look at the repair section. If a repair for an orthosis that includes
specific LCodes, such as ankle or knee joints, is performed, the
reimbursement for this repair will only include the LCodes involved. No
other fees, including labor will be allowed even though this service
will undoubtedly be below your cost. This kind of policy will eventually
lead to the demise of responsible O&P care for the Medicare disabled.
Who in their right mind would replace a pair of joints for the price of
the LCodes allocated by Medicare? Moral of story. I believe O&P repairs
will soon be a thing of the past. How could they not be?
Wil Haines, CPO
MaxCare Bionics
Avon, IN 46123
On 12/17/2012 8:02 PM, Jennifer Wolbach wrote:
> Hi all,
>
>
> I just wanted to asked if anyone knew if Occupationall Therapy is also included in RAC audits. Since I hear that (a certain) OT is billing for LCodes and initial eval. How I see it, they are getting paid twice for the same things that I would do when it comes to bracing. They dont seem to care/know that Lcodes include evals/fitting and follow ups....
>
>
> Thank you,
>
> Jennifer Wolbach
> Orthotist Resident
>
>
> ________________________________
> The documents accompanying this email transmission are CONFIDENTIAL.
>
> Information contained in this email transmission belongs to the facility sending the data and is legally privileged. The information accompanying this email transmission is intended only for the use of the individual (or facility) identified as recipient. The recipient of this information is prohibited from disclosing, copying, distributing or using this information except as permitted by current law governing privacy of information issues. Such information must be destroyed after its stated need has been fulfilled, unless otherwise prohibited by law.
>
> If you have received this email transmission in error, please notify the sender immediately for return instructions at 800 726-9180.
>
>
should be done in the near future inasmuch that Medicare seems to lend a
deaf ear to O&P logic. It is undoubtedly a double standard that has been
going on for years and if the RAC auditors challenged this issue,
Medicare would likely claw back a lot more money. Furthermore, when
physicians use the LCode system, they too become Suppliers and
temporarily step out of the physician arena. Eventually, some of us may
have to challenge Medicare in court on this issue. A double standard is
a double standard. In the meantime, audits are increasing and the pain
is just beginning on a national basis. Furthermore, in addition to
Medicaid audits, similar audits are being implemented by independent
third party insurance companies. They too see the value in clawing back
money from health care providers.
If you read the new upcoming rules for lower limb orthotics, I think you
will be surprised by what you see. Look at the proximal termination
requirement for an AFO. Obviously, someone in authority at Medicare does
not understand the mechanics of nor the nomenclature of O&P. Then, take
a look at the repair section. If a repair for an orthosis that includes
specific LCodes, such as ankle or knee joints, is performed, the
reimbursement for this repair will only include the LCodes involved. No
other fees, including labor will be allowed even though this service
will undoubtedly be below your cost. This kind of policy will eventually
lead to the demise of responsible O&P care for the Medicare disabled.
Who in their right mind would replace a pair of joints for the price of
the LCodes allocated by Medicare? Moral of story. I believe O&P repairs
will soon be a thing of the past. How could they not be?
Wil Haines, CPO
MaxCare Bionics
Avon, IN 46123
On 12/17/2012 8:02 PM, Jennifer Wolbach wrote:
> Hi all,
>
>
> I just wanted to asked if anyone knew if Occupationall Therapy is also included in RAC audits. Since I hear that (a certain) OT is billing for LCodes and initial eval. How I see it, they are getting paid twice for the same things that I would do when it comes to bracing. They dont seem to care/know that Lcodes include evals/fitting and follow ups....
>
>
> Thank you,
>
> Jennifer Wolbach
> Orthotist Resident
>
>
> ________________________________
> The documents accompanying this email transmission are CONFIDENTIAL.
>
> Information contained in this email transmission belongs to the facility sending the data and is legally privileged. The information accompanying this email transmission is intended only for the use of the individual (or facility) identified as recipient. The recipient of this information is prohibited from disclosing, copying, distributing or using this information except as permitted by current law governing privacy of information issues. Such information must be destroyed after its stated need has been fulfilled, unless otherwise prohibited by law.
>
> If you have received this email transmission in error, please notify the sender immediately for return instructions at 800 726-9180.
>
>
Citation
Wil, “Re: OTs and RAC audits,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/234398.
