In the April 20, 2017 AOPA in Advance: SmartBrief newsletter, AOPA announced that Performant Recovery, the contractor who serves as the national recovery audit contractor (RAC) for all Medicare DMEPOS, Hospice and Home Health services, had announced that it would begin performing an automated review on claims involving HCPCS code L5845 billed in conjunction with specific prosthetic knee codes.
AOPA reviewed the announcement on the Performant website and was immediately concerned that the RAC was not in compliance with its statement of work (SOW) which requires very specific criteria in order to implement an automated review. In a letter to the Performant Recovery Medical Director dated April 28, 2017, AOPA expressed its concern regarding Performant’s decision to initiate an automated review without meeting the specific criteria identified in its statement of work. View the letter.
AOPA has not received a formal response from Performant Recovery addressing its concern. The audit announcement for L5845 has been entirely removed from the “approved issues” section of the Performant Recovery website.