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Linda Collins Blogger

When 99% is not good….

Posted by Linda Collins | August 02, 2013

As we stated in our March 19, 2013 post, New Audit Issue…Watch Your Step, and May 2, 2013, AFO Prepayment Audits…Continued, Medicare continues to audit Ankle-Foot Orthoses. Last week Jurisdiction D announced the results of a widespread pre-payment review of HCPCS code L1960. The results of the prepayment reviews for the first quarter of 2013 show a 99% claims error rate.

Common Errors:

  • 37% of the claims received a denial for not meeting coverage criteria
  • 27% of claims received a denial as the treating physician’s records don’t provide detailed documentation to support medical necessity of custom rather than prefabricated orthosis

What does this mean for you?

  • Review the LCDs and Policy Articles for AFOs.
  • Establish a process for gathering corroborating documentation when supplying a custom-fabricated orthosis.
  • Utilize the AFO Claims Checklist (available under the Reimbursement Resources tab on the left) 

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.

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