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David McGill Blogger

The OIG's Road Forward

Posted by David McGill | February 13, 2014

The Office of Inspector General recently released its 2014 Work Plan. Here are the key issues looming for suppliers:

  • For certain medical equipment (e.g., folding walkers, TENS machines), OIG will review what Medicare pays v. what private payers and the VA pays in an effort to identify potentially wasteful Medicare spending.
  • For lower limb prosthetics, OIG will review suppliers' compliance with the Medicare Benefits Policy Manual's requirements. 

What does this mean for you?

First, the scrutiny of folding walkers and TENS machines pricing is worth watching. In late 2012, OIG opined that Medicare was overspending significantly on spinal orthoses. If Medicare ultimately changes the reimbursement amounts for folding walkers and TENS, it may presage future activity in the bracing space.

Second, the fact that OIG restated the need for ongoing scrutiny of lower limb prosthetics claims (referencing its August 2011 report on the subject) suggests that (a) this remains an area of focus, and (b) the "new normal" of extensive RAC auditing and prepayment claim reviews is likely to continue through 2014. Remember that Ossur's updated Reimbursement Guides and other downloadable resources assist you in capturing the kind of documentation that helps you withstand audits and prepayment claim reviews. Click here to see a full list of those resources.

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