NEW AUDIT ISSUES, HOW TO COMPLY

Our friends at Ossur recently made us aware of three new audit issues, approved by Performant Recovery, which affect Complex Spinal Orthoses, Complex Medical Necessity AFO & KAFO Orthoses, and DME Billed While Inpatient. According to the statement from Ossur, here’s what you need to know:

Complex Spinal Orthoses

Documentation will be reviewed to determine if Spinal Orthoses meet Medicare coverage criteria and/or is medically reasonable and necessary. Affected Codes: L0452, L0480, L0482, L0484, L0486, L0629, L0632, L0634, L0636, L0638, L0640, A9270.

Complex Medical Necessity AFO & KAFO Orthoses

Medical documentation will be reviewed to determine that services were reasonable and necessary. Affected codes: L1900, L1904, L1907, L1920, L1940, L1945, L1950, L1960, L1970, L1980, L1990, L2106, L2108, L4631, L2000, L2005, L2010, L2020, L2030, L2034, L2036, L2037, L2038, L2126, L2128

DME Billed While Inpatient

A supplier may deliver a DMEPOS item to a patient in a hospital or nursing facility for fitting or training the patient in the proper use of the item. This may be done up to two (2) days prior to the patient’s anticipated discharge to their home. The supplier should bill the date of service on the claim as the date of discharge and shall use the place of service (POS) as 12 (patient’s home). The item must be for subsequent use in the patient’s home.

To ensure compliance and prepare for any audit issues, please review the medical necessity for braces and make sure you have the proper physician’s documentation. Also, as Ossur advises, if you do receive an Additional Documentation Request (ADR) from Performant, be sure to respond with all of the required documentation.

If you need help better understanding audit issues, if your practice is in compliance, or how to deal with an ADR, please contact O&P Insight today and let us help!

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