Chronology of AOPA Actions

Related to RAC Other Audits and Prepayment Reviews

August 11, 2011 DME MAC Medical Directors release “Dear Physician” letter changing the physician documentation requirements for lower limb prosthetics
August 28, 2011 OIG releases its report “Questionable Billing Practices in Lower Limb Prosthetics”
September 6, 2011 O&P Alliance sends letter to then CMS Administrator Donald Berwock challenging CMS acquiescence in OIG report and adverse impact on amputee patient care
September 6, 2011 O&P Alliance writes OIG Director Daniel Levinson challenging several discrepancies in his report and seeking a meeting
September 7, 2011 AOPA CRC writes to DME MAC Medical Directors challenging issues from the Dear Physician letter
September 7, 2011  OPA send letter to CMS Program Integrity head, Dr. Peter Budetti challenging OIG report and seeking a face-to-face meeting
November 1, 2011 Jurisdiction A cites 86% denial rate and 96% absence of documentation of medical necessity in O&P prosthetic claims
November 1, 2011 AOPA outreach to physicians
November 9, 2011 AOPA and O&P Alliance Partners meeting with Dr. Peter Budetti (Program Integrity)
February 2012  O&P Alliance meeting with OIG staffers responsible for preparation of the report
February 13, 2012 O&P Alliance meeting with Laurence Wilson, CMS Chronic Care chief
February 15, 2012 AP article, arising from OIG report data, challenging 30+% in prosthetic foot costs released (AOPA President and Executive Director had multiple conversations with AP reporter trying to correct his misstatements/misunderstandings
February 16, 2012 AOPA prepares “Talking Points” made available to members on the AP article and the OIG report more generally
March, 2012 AOPA establishes ‘back channel’ communication with CMS Administrator Tavenner’s office
March, 2012 AOPA Executive Director monthly letter addresses issues in physician documentation
March 8, 2012 AOPA secure letter from Senator Cardin to CMS Administrator Tavenner expressing concern about impact on Medicare patient care
April, 2012 During a 30-minute planned ‘meet and greet’ with O&P Alliance representative, CMS Administrator Tavenner raises documentation audits and states need for “middle ground”
April 20, 2012 Jurisdiction A reports claims denial rate on O&P prosthetic claims has reached 90.9%.
April, 2012 AOPA receives unofficial word from CMS Program Integrity staff that while they agreed with AOPA about physician documentation, others at CMS did not agree, so the issue would need to be resolved at the CMS Administrator level
May, 2012 OPA develops and makes available OIG Talking Points
May 8, 2012 O&P Alliance meeting with George Mills, Deputy Director responsible for audit contractors and the DME MAC supervision to try to clarify key points on audits and physician documentation. Dr. Susan Miller agreed with the position that the prosthetist’s records/notes, when they are entered into the doctor’s patient file legitimately become  part of the medical record, and she promised to correct the position to the contrary that had been conveyed by DME MAC Medical Directors. Dr. Miller also invited AOPA to submit some examples of some claims reviews which AOPA believed were particularly egregious.
June, 2012  AOPA begins advertising on physician documentation/audits issue to policy makers in the D.C market.
June 7, 2012 CMS revises aspects of its response to OIG—release of MLN—“if a supplier is replacing an old prosthesis and there is no upgrade in the model, the supplier does not need a physician order. Also, the “ordering “ physician need not be a surgeon and may be the beneficiary’s primary care physician.
June 8, 2012 House Energy and Commerce Committee conducts a hearing about complains generally about RAC audits.
June 12, 2012 AOPA issues member bulletin outlining changes included in the June 7 MLN.
June 27, 2012 AOPA submits position paper, draft questions and examples of egregious claims to Senate Finance Committee
July 30, 2012 AOPA submits 8 egregious claims to CMS’ Dr. Susan Miller.
August 16, 2012 Plan for briefing call with Marwood and M. Carkhuff
August 20, 2012 Executive Director’s memo “Is It Legitimate for CMS Auditors to Hold O&P Facilities to Ramped Up Physician Documentation Requirements as to Claims Field before the Release of the OIG Report on August 28, 2012—set process in motion to consider legal challenge to CMS/contractor actions
August 21, 2012 Report for DME MAC Jurisdiction A shows reduction in error rate from 90% to 75%
August 22, 2012 AOPA initial contact with Winston Strawn seeking brief summary of litigation options
August 22, 2012 Fise email to CMS Administrator Tavenner seeking meeting, she responds agreeing to meet.
August 28, 2012 AOPA advice from Scully on seeking press coverage of patients. Care denied/delayed
August 31, 2012 O&P Alliance submits letter to CMS on face-to-face physician meeting requirement.
August 31, 2012 AOPA requests cost estimate on litigation option
September 10, 2012 Fise meeting set with Rep. Brett Guthrie (R-KY)
September 11, 2012 Follow-up (2) Exec Dir letter on audits released to AOPA members
October 1, 2012 AOPA prepares materials explaining Medicare Extended Repayment Plan for recoupments to members
October 3, 2012 AOPA reviews/circulates ann. data released by CMS on success rates of RAC audits
October 3, 2012 OIG Releases its 2013 Work Plan indicating continued O&P focus and displaying fundamental misunderstandings of how O&P care is delivered. Topic added to Tavenner meeting agenda
October 4, 2012 Jurisdiction B Manual highlights plans for addition of major prepayment audits
October 5, 2012 AOPA secure letter from Rep. Guthrie to CMS Administrator Tavenner expressing concern about impact on Medicare patient care
October 9, 2012 Call set with Messrs. Kritter and Oros to plan for Tavenner meeting
October 10, 2012 AOPA conference call with Mills, Miller of CMS on egregious audits—CMS upholds claims
October 15, 2012 Meeting with Administrator Tavenner – summary of meeting and documents provided by AOPA reps
October 19, 2012 Materials received from Al Kritter as part of follow-up materials promised to T avenner
October 22, 2012 AOPA circulates chapter 29 of the Medicare Claims Processing Manual. This chapter clearly outlines exactly how each level of appeal is supposed to be handled
November 1, 2012 AOPA report on AHA suit against CMS over hospital RAC audits, received legal summary
November 13, 2012 AOPA communication with House Ways & Means Committee staff over H.R. 6575—hospital backed legislation on RACs targeting hospitals.
November 14, 2012 AOPA provides summary of H.R. 6575, pos and cons of hospital bill for AOPA members
November 27, 2012 AOPA lobbyist L.F. Payne contacts Tavenner office on meeting follow-up pending 12/1
December 5, 2012 AOPA provides assessment on prospects of: (1) rule making on quality provider (80%); (2) moratorium of some type on new/retroactive audits (50/50); (3) AOPA litigation (35%)
December 13, 2012 AOPA member summary—What Is AOPA Doing About RAC Audits?
December 13, 2012 AOPA provides selected materials and summary to non-member to rebut multiple misconceptions conveyed on the O&P List Serv
December 14, 2012 Subgroup of AOPA Board sets meeting for discussion of further options
December 14, 2012 AOPA Counsel, Winston & Strawn delivers legal letter to CMS Adm Tavenner summarizing all deficiencies that could be subjected to legal challenge
December 18, 2012 AOPA receives communication from office of House W&M Cte member Rep. Roskam (R-IL) seeking meeting as follow-up on expression of constituent concerns on RACs
December 19, 2012 AOPA Board Subgroup meets
December 20, 2012 Result of AOPA Board Subgroup, materials from some companies circulated
January 2, 2013 AOPA considers prospect of information to members on resources for Assist with ALJ
January 13, 2013 AOPA provides information on OIG report relating to Premier Prosthetics
January 13, 2013 AOPA lobbyists L.F. Payne renews contact with Tavenner office, including reminder that she said in meeting that if their data shows that there is a large % of these audit findings that are reversed upon appeal to ALJ, that would be a strong indicator of need to change.
January 14, 2013 AOPA begins process for special survey of members in Jurisdiction B on pre- pay audits
January 15, 2013 AOPA prepares/releases overview of RAC audit limits-response to excess # of claims review.
January 18, 2013 AOPA begins sharing with Winston & Strawn cases of retrospective audits
January 21, 2013 AOPA/Alliance receive word of AAHomeCare with GAO about RAC audits, outreach to GAO
January 22, 2013 First conference call of AOPA litigation subcommittee with Winston & Strawn
January 22, 2013 Follow-up materials to Winston & Strawn about DME MAC communications of documentation requirements
January 24, 2013 Jurisdiction B releases new policy info on K levels
January 25, 2013 Jurisdiction D releases new info on prepayment audits of selected high-end prosthetic codes
January 25, 2013 AOPA shares into in new Jurisd. B and D policies with the Amputee Coalition
January 25, 2013 Training material provided by NHIC Region A on October 6, 2011 shared with legal counsel
January 25, 2013 AOPA prepares a few samples of business/cash flow impact of audits to be shared with CMS Administrator’s office
January 30, 2013 AOPA begins process of trying to assemble info on patient impact for Amputee Coalition on delays and/or reduced quality of care for Medicare benficiaries
January 31, 2013 AOPA decides to initiate a renewed RAC audit survey, expanded to gather some new information
February 1, 2013 AOPA Board members provide Winston & Strawn with more cases of retrospective audits
February 4, 2013 AOPA Member request to Rep. Quigley
February 5, 2013 AOPA Member request to Rep. Chabot
February 6, 2013 CMS releases report asserting $940 million Medicare savings via RACs
February 7, 2013 AOPA emails info on 2 topics: (1) the CMS press report on $940 million savings and (2) history on AOPA’s providing questions, cases and postion paper to Senate Finance Commitee in 6/12
February 7, 2013 AOPA determines and communicates to AOPA members that Jurisdiction A RAC using incorrect formula to set RAC audit limits on number of claims audited.
February 8, 2013 Second version of RAC Audit Re-Survey approved and finalized for distribution
February 10, 2013 AOPA submits proposed agenda for meeting with CMS Deputy Director of Payment Policies on RACs and Impact on O&P Businesses’ Cash Flow
February 11-15, 2013 AOPA Exec Director’s meetings with staffs of Reps. Quigley (IL), Chabot (OH), Griffen (AR), Whitfield (KY), Blackburn (TN) and Senator Harkin (IA)
February 27, 2013 Date set for O&P Alliance conference call for GAO on RACs
March 1, 2013 AOPA 2nd RAC Audit Survey Report
March 8, 2013 Fise meeting with Rep. Jenkins (R-KS)
March 8, 2013 AOPA Files 4 Letters to CMS’ George Mills (responsible for auditor and DME MAC supervision) on: (1) Jurisdiction B statements on prosthetist’s note not in medical record; (2) Jurisdiction D. pre-payment audits’ discriminatory impact; (3) Jurisdiction B—K-level standard is discriminatory against patients; (4) limits on # of Additional Documentation Requests for O&P
March 11, 2013 Communications with Senator Cornyn’s office
March 11-12, 2013 AOPA Policy Forum and 350 appointments with legislators and staff telling RAC Audit horror stories.
March 15, 2013 Communications with Senator Hatch’s office; Communications with Senator Rubio’s office; AOPA prepares, submits to Senate possible questions for Tavenner Confirmation
March 18, 2013 Tom Fise meets with Aryana Khalid, Chief of Staff to Administrator Tavenner who makes first mention to AOPA about a new CMS physician template in process for O&P; CMS Staff tell TN Senate staffers that CMS has been working with AOPA on a physician template draft; AOPA receives responses from CMS’ George Mills on AOPA letters on Jurisdiction D Pre-Payment Audits being discriminatory, and inappropriate auditor calculation of ADR limits.
March 18, 2013 Fise meeting with Megan Spindel, Legislative Director for Rep. Guthrie.
March 19, 2013 Tom Fise follow-up conference with Sen. Gillibrand staff; CMS affords special admin. relief to hospitals on RACs; AOPA lobbyist, Tom Scully, speaks directly with CMS Administrator Tavenner to urge solution.
March 20, 2013 AOPA prepares letter to Rep. Shimkus, follow-up on Policy Forum
March 21, 2013 Fise attends Rep. Duckworth fundraiser
March 26, 2013 AOPA mounts member outreach to legislators on Duckworth-Guthrie sign-on letter to Secretary Sebelius; Tom Fise and Dennis Williams of Fillauer participate in meeting with staffers from both TN Senators
March 27, 2013 AOPA prepares letter to Rep. Pingree, follow-up on Policy Forum – AOPA publishes 9-point history of flaws with OIG report, “Dear Physician” letter and audits
March 29, 2013 AOPA prepares letter to Rep. Kingston, follow-up on Policy Forum
April 3, 2013 CMS reduces maximum number of Additional Documentation Requests (ADRs) for O&P audits, in response to AOPA letter
April 10, 2013 AOPA prepares input to Appropriations Committee on audit issue George Mills responds to AOPA letters (re: Jurisdiction B) on legitimate role of prosthetist’s notes, and K-level, AOPA responds.
April 11, 2013 CMS reverses position form MLN on June 7, 2013 – physician order required for all replacement prostheses, even if no change from patient’s prior prostheses.
April 11, 2013 Tom Fise and Dennis Williams of Fillauer participate in meeting with staffers from both TN Senators, George Mills and other CMS staff.
April 13, 2013 CMS’ George Mills responds to AOPA email of April 10
April 15, 2013 Joint letter to HHS Secretary Sebelius and Administrator Tavenner authored by Rep. Duckworth (D-IL) and Rep. Guthrie (R-KY) also signed by 35 colleagues.
April 18, 2013 Amputee Coalition issues Position Statement on Audits.
April 19, 2013 AOPA meeting with Rep. Duckworth’s staff
April 15, 2013 Final Winston Strawn Attorney Mills Letter to Administrator Tavenner
May 6, 2013 AOPA prepares new, updated one-pager for Hill on RACs, pre-payment audits
May 8, 2013 AOPA/O&P Alliance Meeting with Administrator Tavenner
May 10, 2013 AOPA files lawsuit against CMS seeking relief from audits

Access the Compendium of Relevant Documents here