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Linda Collins Blogger

New Audit Issues Listed for O&P

Posted by Linda Collins | August 25, 2017

Performant Recovery, the recovery audit contractor for DME and O&P, has posted three new audit issues:

1. Complex Spinal Orthoses

Documentation will be reviewed to determine if Spinal Orthoses meet Medicare coverage criteria and/or is medically reasonable and necessary. Affected Codes: L0452, L0480, L0482, L0484, L0486, L0629, L0632, L0634, L0636, L0638, L0640, A9270.

2. Complex Medical Necessity AFO & KAFO Orthoses

Medical documentation will be reviewed to determine that services were reasonable and necessary. Affected codes: L1900, L1904, L1907, L1920, L1940, L1945, L1950, L1960, L1970, L1980, L1990, L2106, L2108, L4631, L2000, L2005, L2010, L2020, L2030, L2034, L2036, L2037, L2038, L2126, L2128

3. DME Billed While Inpatient

A supplier may deliver a DMEPOS item to a patient in a hospital or nursing facility for fitting or training the patient in the proper use of the item. This may be done up to two (2) days prior to the patient's anticipated discharge to their home. The supplier should bill the date of service on the claim as the date of discharge and shall use the place of service (POS) as 12 (patient's home). The item must be for subsequent use in the patient's home.

What does this mean for you?

  • If you receive an Additional Documentation Request (ADR) from Performant, be sure to respond with copies of all documentation.
  • Review the medical necessity criteria for braces and double check yours and the physician's documentation.
  • Download resources here.
  • Click here for more information about Performant Recovery and the approved audit issues.
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