The American Orthotic and Prosthetic Association has issued a letter to Performant Recovery — the national recovery audit contractor for all Medicare durable medical equipment, prosthetics, orthotics and supplies companies, hospice and home health services — about an announcement by the contractor to perform an automated review.
The automated review would be for claims involving the Healthcare Common Procedure Coding System code L5845 billed in conjunction with specific prosthetic knee codes, according to a statement by the American Orthotic and Prosthetic Association (AOPA).
The AOPA reviewed the announcement and grew concerned that Performant Recovery was not in compliance with its statement of work, which requires “very specific criteria in order to implement an automated review,” according to the AOPA statement. The full letter from Michael H. Oros, president of AOPA to Mary Pascucci, DO, medical director for Performant Recovery, can be viewed at www.aopanet.org/wp-content/uploads/2017/05/Letter-to-Performant-Recovery-L5845.pdf.
According to the statement, Performance Recovery has not released a formal response. However, the audit announcement for L5845 has been removed from the approved issues section of the Performant Recovery website.
“AOPA will continue to monitor this issue closely and will report any additional developments as they occur,” the statement noted.
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Disclosures: Oros and Pascucci report no relevant financial disclosures.
