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Linda Collins Blogger

AFO Prepayment Audits...continued

Posted by Linda Collins | May 02, 2013

As we stated in our March 19, 2013 post, New Audit Issue…Watch Your Step, Medicare continues to audit Ankle-Foot Orthoses.  Last week Jurisdiction D announced the results of a widespread pre-payment review of HCPCS codes L4360, L1970 and L1960. A summary of the results of the prepayment reviews for the first quarter of 2013:

L4360 WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT  

Common Errors:

  • No proof of delivery submitted.
  • No detailed written order or dispensing order received

L1960 ANKLE FOOT ORTHOSIS, POSTERIOR SOLID ANKLE, PLASTIC, CUSTOM-FABRICATED

L1970 ANKLE FOOT ORTHOSIS, PLASTIC WITH ANKLE JOINT, CUSTOM-FABRICATED

  • No detailed documentation to support medical necessity of custom rather than prefab orthosis

What does this mean for you?

  • Review your product delivery process and assure you are providing detail, signatures and dates.
  • Create a Detailed Written template for your practice that includes all required information.
  • Establish a process for gathering corroborating documentation when supplying a custom-fabricated orthoses.

Practitioners in Jurisdiction D can continue to expect pre-payment reviews of AFO claims. The other three regions may also institute audits.  The best way to minimize the impact of an audit is to follow the product definitions, codes and diagnoses outlined in the LCDs and Policy Articles. Other resources include:

The Reimbursement Resources will direct you to additional downloadable resources including an AFO Claims Checklist and an Orthoses Claims Documentation Guide.

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