News

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PECOS Edits for Ordering/Referring Physicians is Delayed

CMS has announced that Phase 2 of the PECOS edits for ordering/referring physicians is now delayed and a new effective date has not been announced. Claims where there is no PECOS record for the referring/ordering physician were set to be denied on May 1, 2013. This means that your current Medicare claims will not be […]

Jurisdiction D DME MAC Releases Pre-Payment Review Results

Noridian Administrative Services, LLC, the Jurisdiction D DME MAC has recently released results of two ongoing widespread pre-payment reviews; one for diabetic shoes described by A5500 and the other for AFOs described by codes L4360, L1960, and L1970.  All reported results involve claims that were reviewed between December, 2012 and March 2013. For diabetic shoes […]

Compassionate Care Access Offered to Boston Marathon Amputee Victims

ALEXANDRIA, VA, April 22, 2013 – The American Orthotic and Prosthetic Association (AOPA) is leading a coalition to provide access to care for uninsured/underinsured amputee victims of the Boston Marathon Bombing to assure that all victims “will walk and run again”. Leaders of manufacturer and patient care facility members of AOPA and coalition partners have […]

AOPA Continues Dialogue with OIG Regarding L0631 Spinal Orthoses

In an April 19, 2013 letter to Inspector General Daniel Levinson and Deputy Inspector General for Evaluation Stuart Wright, AOPA addressed several concerns regarding assertions that were made in the OIG response to AOPA’s comments on the December 2012 OIG report entitled Medicare Supplier Acquisition Costs for L0631 Back Orthoses. AOPA provided initial comments on […]

AOPA Letter to Tavenner and Sebelius Further Challenges “Dear Physician” Letter

AOPA’s counsel on CMS matters, Tom Mills of the law firm Winston and Strawn, has issued a second letter to HHS Secretary Sebelius and CMS Acting Administrator Tavenner again seeking withdrawal of the “Dear Physician Letter” which unleashed the horrendous increase in RAC and other audits as well as burdensome prepayment reviews.  All of these […]

AOPA Members Rally to Secure 35 Representatives to Sign-On to HHS Secretary Sebelius Letter

Those who attended the AOPA Policy Forum March 12-13 started the effort in their Congressional visits to persuade their Representatives to sign-on to a letter from Rep Duckworth (D-IL) and Rep. Guthrie (R-KY) to HHS Secretary Sebelius expressing concerns about CMS audit procedures.  A follow-up campaign, by directed at the entire AOPA membership, generated action […]

AOPA Plans to Testify in Upcoming SBA Hearing on Regulatory Fairness

There is an upcoming Regional SBA Hearing being held in Seattle, WA on June 6th titled “Regulatory Fairness Hearing for Small Business.”  AOPA will be testifying on behalf of our members on the RAC and Pre-payment audit practices jeopardizing the economic viability of our members. This hearing is being held by the U.S. Small Business […]

Policy Forum Makes Big Impact on Raising Congressional Concerns over RAC Audits

AOPA Executive Director, Tom Fise, brought the Board of Directors up to date in a recent email on how AOPA members attending the Policy Forum took the lead in urging their legislators in the House of Representatives to sign-on to the letter Rep. Tammy Duckworth and Rep Brett Guthrie will send to HHS Secretary Sebelius.  […]

HHS Inspector General Takes Swipe at L0631

Writing in AARP The Bulletin, Daniel R. Levinson repeats a faulty assertion first made in the Office of Inspector General Report of December 2012 that Medicare paid an average of $919 for L0631 coded back braces that could be bought on the Internet for $191.  The Medicare reimbursement was supposed to include ongoing clinical care […]

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