Highlights 1

Summary of AOPA Correspondence to CMS Regarding Egregious Contractor Behavior

AOPA recently submitted four separate letters to George Mills, the CMS official with oversight authority over CMS contractors, including both the DME MACs and the Recovery Audit Contractors.  The purpose of these letters was to request immediate CMS intervention regarding egregious activities by the DME MACs, specifically in Jurisdiction B and Jurisdiction D, as well as Performant Recovery, Inc., the Jurisdiction A Recovery Audit Contractor.

The letters, which can be viewed in the links below, question the appropriateness and legality of recent audit activity in Jurisdiction D related to the provision of advanced technology prosthetic feet as well as a recent announcement from Jurisdiction B regarding the invalidity of prosthetist notes that are reviewed by the prescribing physician and incorporated into the patient’s medical record.  In addition, AOPA challenged the recent practice of Jurisdiction B medical review staff using patient healthcare factors unrelated to their prosthetic care as a basis for disputing the functional level assessment performed by the physician and the prosthetist.  The final letter discusses the incorrect application of calculations used to determine the number of additional documentation requests (ADRs) a RAC auditor may send to a supplier every 45 days.  Performant Recovery, Inc., the Jurisdiction A RAC contractor has been using the methodology that applies to providers rather than the methodology applicable to suppliers, resulting in an inflated number of ADR requests.  While Performant Recovery has been notified of this error and has taken corrective action, AOPA believes it represents yet another example of poor CMS oversight of its contractor activities.

AOPA continues to fight the battle against irresponsible and egregious behavior by CMS and its contractors and is working to ensure that its members are treated fairly and with respect when providing clinically appropriate care to Medicare beneficiaries.

Jurisdiction D pre-payment audit discriminatory impact

Jurisdiction B K-level policies discriminatory impact

Jurisdiction B statement excluding prosthetist’s notes

Recalculation methodology

See a table that summarizes AOPA correspondence.