National Government Services (NGS), the Jurisdiction B DME MAC, recently reported results of their first quarter pre-payment audit activity on high error rate services, including orthotics and prosthetics.
While the overall error rate for all claims reviewed remains relatively high at 72%, NGS reported that the error rate for O&P claims has been significantly reduced. In July 2012, NGS reported a 100% error rate for O&P claims. In the first quarter of 2013, the error rate for O&P claims has been reduced to 46%, representing a 54% improvement from July 2012.
While NGS has not indicated that this error rate reduction is enough to remove O&P from the list of services subject to pre-payment review, they did indicate that they are encouraged by the significant reduction in the error rate. The most common causes for denial of O&P claims were improper proof of delivery, incomplete medical records to support the medical need of the service provided, and failure to respond to additional documentation requests.
AOPA encourages its members to continue to provide as much information as possible in response to requests for additional documentation. A continued reduction in the pre-payment error rate may ultimately result in removal of O&P services from the pre-payment review process.