Ellmers Bill: NAAOP Position
NAAOP
Description
Collection
Title:
Ellmers Bill: NAAOP Position
Creator:
NAAOP
Date:
9/10/2014
Text:
NAAOP also supports the Ellmers legislation, H.R. 5083, and for good reason.
First off, the key to the bill is explicit recognition of the prosthetist's
clinical notes as part of the medical record. In my law firm's extensive
experience with recent lower limb prosthetic appeals, this is the reason why
these claims are being denied, forcing them into the appeals process. O&P
denials that are not overturned in the provider's favor are usually lost
because the ALJ feels bound not to even consider the clinical notes of the
prosthetist. This is based on the Local Coverage Determinations which state
that supplier-generated documents are not part of the medical record. The
Ellmers bill would help this situation immensely, so we will have to
disagree on your interpretation of this language.
In addition, your critique of the bill omitted two other important
provisions, one that pulls out of a provider's error rate calculation any
denial that is being appealed or that is overturned through the appeals
process. This alone would dramatically improve error rates for O&P claims
and would be a much more accurate way of tracking error rates. Finally, the
bill also separates DME claims from O&P claims (rather than lumping them
altogether) so our profession would be able to demonstrate that O&P is a
very small part of the DMEPOS audit problem.
The bulk of your critique of the bill centers on language that does not
relate specifically to O&P, nor did NAAOP (or AOPA for that matter) ask to
have included in the bill. Nonetheless, contractors tend to focus on high
dollar claims and areas where there appears to be significant
overutilization. This is already occurring so the conclusion that the
bill's language will cause this to take place is questionable. According to
the bill's sponsors, this language is intended to benefit providers,
including O&P practitioners, who make great efforts to comply with
documentation requirements and, under the bill's language, would receive
fewer audits as a result.
Congresswoman Renee Ellmers (R-NC) has now introduced the Injured and
Amputee Veterans Bill of Rights (H.R. 3408) and this Medicare audit bill,
H.R. 5083. She is a real champion for O&P patients and the providers who
serve them. She serves on the Majority Party in the House of
Representatives and is a strong ally to the profession. Please think twice
about firing off letters to her office complaining about a bill that she
intended would, and in fact does, help the O&P profession. For more
information, please go to www.naaop.org.
Peter W. Thomas
General Counsel, NAAOP
Please visit our website at: www.naaop.org
NAAOP
1501 M Street, NW
7th Floor
Washington, DC 20005-1700
e-mail: <Email Address Redacted>
(800) 622-6740
(202) 624-0064 Phone
(202) 785-1756 Fax
www.naaop.org
First off, the key to the bill is explicit recognition of the prosthetist's
clinical notes as part of the medical record. In my law firm's extensive
experience with recent lower limb prosthetic appeals, this is the reason why
these claims are being denied, forcing them into the appeals process. O&P
denials that are not overturned in the provider's favor are usually lost
because the ALJ feels bound not to even consider the clinical notes of the
prosthetist. This is based on the Local Coverage Determinations which state
that supplier-generated documents are not part of the medical record. The
Ellmers bill would help this situation immensely, so we will have to
disagree on your interpretation of this language.
In addition, your critique of the bill omitted two other important
provisions, one that pulls out of a provider's error rate calculation any
denial that is being appealed or that is overturned through the appeals
process. This alone would dramatically improve error rates for O&P claims
and would be a much more accurate way of tracking error rates. Finally, the
bill also separates DME claims from O&P claims (rather than lumping them
altogether) so our profession would be able to demonstrate that O&P is a
very small part of the DMEPOS audit problem.
The bulk of your critique of the bill centers on language that does not
relate specifically to O&P, nor did NAAOP (or AOPA for that matter) ask to
have included in the bill. Nonetheless, contractors tend to focus on high
dollar claims and areas where there appears to be significant
overutilization. This is already occurring so the conclusion that the
bill's language will cause this to take place is questionable. According to
the bill's sponsors, this language is intended to benefit providers,
including O&P practitioners, who make great efforts to comply with
documentation requirements and, under the bill's language, would receive
fewer audits as a result.
Congresswoman Renee Ellmers (R-NC) has now introduced the Injured and
Amputee Veterans Bill of Rights (H.R. 3408) and this Medicare audit bill,
H.R. 5083. She is a real champion for O&P patients and the providers who
serve them. She serves on the Majority Party in the House of
Representatives and is a strong ally to the profession. Please think twice
about firing off letters to her office complaining about a bill that she
intended would, and in fact does, help the O&P profession. For more
information, please go to www.naaop.org.
Peter W. Thomas
General Counsel, NAAOP
Please visit our website at: www.naaop.org
NAAOP
1501 M Street, NW
7th Floor
Washington, DC 20005-1700
e-mail: <Email Address Redacted>
(800) 622-6740
(202) 624-0064 Phone
(202) 785-1756 Fax
www.naaop.org
Citation
NAAOP, “Ellmers Bill: NAAOP Position,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/236738.
