UPDATED: Report: CMS Rescinds RAC Audits on Claims Prior to 2011


CMS says auditors improperly sent letters out on orthotic and prosthetic claims. Only audits on power mobility devices have been limited to a twelve month look back period. This was necessitated by the prior authorization project for PMD’s which began in August 2012.

The Centers for Medicare and Medicaid Services (CMS), through their independent audit contractors, recently sent letters to multiple orthotic and prosthetic practices informing them that all orthotic and prosthetic recovery audits with dates of service prior to 2011 will officially be rescinded.

A justification for the policy change has not been released by CMS, but the August 2011 date does coincide with the timing that CMS released their “Dear Physician” letter detailing the new interpretation of existing documentation requirements. While not a force of law, the letter essentially changed CMS policy and took the professional opinion of the prosthetist out of documenting medical necessity. We are still awaiting an official release from CMS.

As more information from CMS becomes available, OPGA will continue to keep you informed of new developments. OPGA will also continue to work for independent orthotic and prosthetic practitioners behalf to ensure we don’t just win the battle, but the larger war with CMS over the clinical judgement and expertise of certified orthotists and prosthetists. CMS has shown a chink in their armor, now is the time to continue to press the importance of the clinical nature of orthotists and prosthetists and OPGA will be rolling out new tools and ideas, to be house as part of Speak4OandP.com, that will help your practice do just that.


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