Renewed Hope for Relief from Recent O&P Challenges – Medicare O&P Improvement Act


Seldom does a single piece of legislation do so much for a vital segment of patients and healthcare providers as does the new version of the Medicare O&P Improvement Act of 2015 introduced by Sen. Grassley (R-IA) and Sen. Warner (D-VA) in the Senate (S. 829).  The House bill (H.R. 1530 was introduced by Rep. Glenn Thompson (R-PA) and Rep Mike Thompson (D-CA)  Three of the four have previously sponsored versions of the bill and adding Sen. Warner continues the bipartisan support this legislation has always generated.

Introduction of the bills on March 23, 2015, on the opening day of AOPA’s Policy Forum,  paves the way for O&P’s relief from the following patient care and business disruptions experienced over the past five years by:

  • Curbing overzealous audits
  • Denying payments to unlicensed/unqualified providers
  • Recognizing orthotists’ and prosthetists’ notes by stating that they “shall be considered part of the medical record”
  • Separating orthotics and prosthetics from durable medical equipment
  • Resolve the illegal delays for appealing denied claims to the Administrative Law Judge (ALJ), by adjustments to the recoupment policy
  • Offering voluntary negotiation process to provide a prompt equitable settlement such as made available to hospitals
  • Requiring CMS to separate appeals process data so O&P claim outcomes are tracked and reported separately from other DME claims
  • Mandating CMS to adhere to the statutory definition of off the shelf orthotics eligible for competitive bidding as only being those needing “minimal self adjustment” by the patient, and no other person.

Go to http://www.aopanet.org/legislative-regulatory/2015-policy-forum/ to view the bills and talking points.

But That’s Not All – Rep. Meadows (R-NC) introduced H. R. 1526 – The Medicare Audit Improvement Act of 2015!

Improvements to the existing chaotic RAC audit situation is exactly what Rep. Meadows’ bill accomplishes through provisions that recognize that the orthotists’ and prosthetists’ notes “shall be considered as part of the medical record of the individual.”  The bill also requires CMS to separately report determinations made on O&P claim denials/appeals as well as the HCPCS codes accounting for the greatest number of determinations and the total dollars involved.  Under the bill no more than “half of the amount of any payments made” to a qualified supplier may be recouped before that appeals process for such a claim is treated as exhausted.

Joining as a co-sponsor of the Medicare O&P Improvement Act (S. 829) should be the “ask” to your Senator and joining as a co-sponsor for the House version (H.R. 1530) and the Medicare Audit Improvement Act of 2015 (H.R. 1526) should be the “ask” to your representative.  Go to aopavotes.org to access template letters for all three bills, and talking points.