Re: Who else are being audited?
CAAT-SOLUTIONs
Description
Collection
Title:
Re: Who else are being audited?
Creator:
CAAT-SOLUTIONs
Date:
3/27/2013
Text:
Hello,
Just a few weeks ago I attended a DME MAC C meeting where the L0631 & L0637 concerns were discussed in detail. It was indicated that yes the PT's, Physicians etc. were also being audited. The claim selection system is unbiased in that it randomly selects claims with the flagged procedure code (at least at the DME MAC pre-payment level). Most times your PT's & Physicians bill solely what is indicated by the manufacturer and as we all know, you cannot depend on manufacturer coding recommendations.
They did recognize that this problem stems from the broad descriptions of the procedure codes, elimination of more appropriate procedure codes, fitters (such as PT's) who do not regularly bill for these services and misinformation from reps. AOPA has been very involved in combatting these audits and trying to work with CMS for a more appropriate solution. At this time however these efforts have not been enough to cease the audits.
Sincerely,
Nicole Godwin-Burns
Vice President
Compliance AccountAbility & Training Solutions, LLC
P.O. Box 225
Danville, IN 46122
P: (877) 220-9379
On Mar 26, 2013, at 6:56 PM, Albert J Garney < <Email Address Redacted> > wrote:
> Greetings everyone:
>
> I have a quick question. Is it only the O&P professionals being audited or are the physicians, physical therapists, companies that have sales people sitting OTS devices also included in these audits?
>
> Case in point with the recent article in the O&P almanac that showed over 61,000 claims on the L0361 were mostly provided by physical therapist, physicians and other DME providers that were not traditional O&P professionals.
>
> In my opinion this is what got us into the current environment and I hope that they are also being included within the Medicare audits.
>
> Albert Garney,CPO
> Prince William Orthotics & Prosthetics
> 8644 Sudley Rd Suite 305
> Manassas VA 20110
>
> www.pwop.net
>
> Office. 703-368-7967
> Cell. 571-247-8641
>
>
Just a few weeks ago I attended a DME MAC C meeting where the L0631 & L0637 concerns were discussed in detail. It was indicated that yes the PT's, Physicians etc. were also being audited. The claim selection system is unbiased in that it randomly selects claims with the flagged procedure code (at least at the DME MAC pre-payment level). Most times your PT's & Physicians bill solely what is indicated by the manufacturer and as we all know, you cannot depend on manufacturer coding recommendations.
They did recognize that this problem stems from the broad descriptions of the procedure codes, elimination of more appropriate procedure codes, fitters (such as PT's) who do not regularly bill for these services and misinformation from reps. AOPA has been very involved in combatting these audits and trying to work with CMS for a more appropriate solution. At this time however these efforts have not been enough to cease the audits.
Sincerely,
Nicole Godwin-Burns
Vice President
Compliance AccountAbility & Training Solutions, LLC
P.O. Box 225
Danville, IN 46122
P: (877) 220-9379
On Mar 26, 2013, at 6:56 PM, Albert J Garney < <Email Address Redacted> > wrote:
> Greetings everyone:
>
> I have a quick question. Is it only the O&P professionals being audited or are the physicians, physical therapists, companies that have sales people sitting OTS devices also included in these audits?
>
> Case in point with the recent article in the O&P almanac that showed over 61,000 claims on the L0361 were mostly provided by physical therapist, physicians and other DME providers that were not traditional O&P professionals.
>
> In my opinion this is what got us into the current environment and I hope that they are also being included within the Medicare audits.
>
> Albert Garney,CPO
> Prince William Orthotics & Prosthetics
> 8644 Sudley Rd Suite 305
> Manassas VA 20110
>
> www.pwop.net
>
> Office. 703-368-7967
> Cell. 571-247-8641
>
>
Citation
CAAT-SOLUTIONs, “Re: Who else are being audited?,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/234924.
