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Linda Collins Blogger

Relief and Call to Action

Posted by Linda Collins | November 12, 2012

The Medicare Audit Improvement Act for 2012, H.R. 6575, was introduced in the House on October 16. Addressing some of the audit issues facing providers, the bill has been referred to the Committee on Ways and Means and to the Committee on Energy and Commerce for consideration.

Key provisions in the bill include:

  • Limiting the number of Medical record requests from contractors
  • Requiring improvements in auditors’ operations, including financial penalties to the auditor for failing to meet stated timelines
  • Penalizing auditors in the case of claims denials overturned on appeal
  • Publicizing information on audit rates, denials, and appeals outcomes by auditor.

What does this mean for you?

These proposed changes, if passed into law, would provide needed relief to O&P providers. To support this proposed bill, you should contact your local representative.
If your representative is a member of the Ways and Means committee it is especially important to make contact.

When communicating with your representative, follow these guidelines:

Express your concerns and the difficulties you face in continuing to provide optimal patient care in today’s audit climate.

  • Provide specific examples of denied claims. For example: “A 67 year-old man who has been a below-knee amputee for 35 years needed a new prosthetic. He is a barber, avid golfer, and enjoys traveling. A K3 prosthesis was provided to him, consistent with previous devices he has received for more than three decades. The denial from the auditor stated there was no history of his prosthetic use.”
  • Provide specific patient examples of delay in patient care due to documentation requirements. For example: “69 year-old female with above-knee amputation has seen three doctors and one physical therapist in past 2 months but is still unable to get a medically-necessary prosthesis because her doctor has been unable to assemble the voluminous and complex data required by Medicare.”
  • Explain the undue emphasis placed on physician documentation. For example: “Physicians will generally acknowledge that they are not subject matter experts when it comes to prosthetics. But requiring their records to nevertheless be the determining factor when auditing a claim does less to deter fraud, and more to deter medically necessary care and treatment to amputees than Medicare intended.”

Encourage your patients to contact their representatives as well. Together we can make our voices heard and influence change in the process.

“Somebody has to do something; it’s just incredibly pathetic it has to be us.” -Jerry Garcia

NOTE: While some of the provisions of HR 6575 apply specifically to Medicare Part A (Hospital) care and treatment, others apply more broadly to Part B, which includes the world of DMEPOS. The central issue is this: for the first time, there is legislation acknowledging issues created by RAC auditors and trying to solve them. HR 6575 provides you a unique opportunity to reach out to your local representative and educate him or her about how RAC audits impact the care you provide. If you do nothing, the effect of this bill on the O&P community could be extremely limited. But if you get involved, the final version could read more broadly and solve key issues facing your business today. The choice is yours.

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