Senate Finance Committee Releases Report Highlighting Audit Issues

Yesterday a bipartisan group of Senate Finance Committee members released a new report entitled “Opportunities to Curb Waste, Fraud and Abuse in Medicare and Medicaid.” Senators included Baucus (D-MT), Hatch (R-UT), Grassley (R-IA), Carper (D-DE), Wyden (D-OR) and Coburn (R-OK). This initiative was created in response to the Finance Committee’s request for stakeholder input on the issue of audits and program integrity efforts relating to payment initiatives and audit contractors.

More than 160 stakeholders from around the country submitted white papers outlining their respective thoughts on program integrity efforts of Medicare and Medicaid programs. OPGA, through our parent company, The VGM Group, submitted comments to the Senate Finance Committee in June of 2012. OPGA/VGM’s white paper can be found VGM Audit White Paper Submission.

Among the many recommendations were several positive proposals relating to audits, payment initiatives and documentation requirements for DMEPOS providers. Below are three key recommendations that independent orthotic and prosthetic practitioners and facilities need to push aggressively to our members of congress, especially those on key committees of jurisdiction, to be part of eventual legislation on program integrity efforts:

• Making numerous process changes to how the various CMS audit contractors operate to ensure they are doing so efficiently and effectively;
• Balancing the incentives for Medicare contractors to identify overpayments with penalties for contractors whose findings are overturned on appeal through the CMS administrative process;
• Creating an advisory panel to provide clinical input as a component of contractor
oversight.

Now is the time to act. www.Speak4OandP.com is your outlet to tell your story of how audits, payment initiatives and documentation requirements are affecting your business and ability to appropriately treat your patients. OPGA will follow up with you and help coordinate communications with your congressional representatives. Many in our profession have a well-deserved cynicism of government action that can actually affect our daily business practices, but this report released by a bipartisan group of Senate Finance Committee members shows that our message is breaking through and lawmakers are listening to the issues we are facing. We need to keep up the fight to ensure these recommendations become reality in the 113th Congress.

ACT NOW! Go to www.Speak4OandP.com today and tell your story!

If you have the time, please view a few of the videos that have been submitted to www.Speak4OandP.com by your colleagues; you will see many of the issues independent practitioners are facing are addressed in the proposals that were highlighted by the Finance Committee report. In addition to the recommendations, below is a sampling of the key proposals that were submitted to the Finance Committee that pertain to orthotic and prosthetic practitioners:

 concern about the sufficiency of efforts to identify and reimburse providers for underpayments;
 concern that over-broad application of the Stark law exception for physician in-office ancillary services compromises patient care by incentivizing overutilization;
 provider and patient frustration with payer documentation requirements, which may lead them to forfeit certain courses of treatment or care.
 the number of audit entities involved (some papers cited duplication among auditing entities or policies, while others called for streamlining the number of entities);
 the volume and complexity of payment rules and regulations;
 whether payment rules are applied consistently and whether audit entities are inappropriately overturning “medical necessity” decisions;
 audit entities’ interactions with providers during the audit process;
 difficulty communicating with audit entities during the audit process;
 burden and cost of documentation requirements; and
 financial burden of payment suspensions and the impact on businesses.
 Increasing penalties and enforcement for perpetrators of fraud, but not for those who make “honest mistakes;”

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View the full report “Opportunities to Curb Waste, Fraud and Abuse in Medicare and Medicaid” HERE

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