Posted June 5, 2014
The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) released a new video webcast in which NAAOP General Counsel Peter Thomas discusses changes developing at the U.S. Department of Veterans Affairs (VA) and at the Centers for Medicare & Medicaid Services (CMS). A summary follows:
VA Secretary Eric Shinseki resigned following more than two weeks of criticism and speculation surrounding the current state of the VA’s healthcare system. . The long-enduring problems associated with the VA healthcare system were just recently brought back into the public eye following the deaths of at least 40 veterans thought to be linked to excessive wait times at the VA hospital system in Phoenix, Arizona. More than 40 other VA locations are being investigated for these same problems. In addition, lengthy waiting times for disability determinations and growing evidence of inconsistent healthcare quality across the United States have fanned the flames of this scandal to the point where significant changes are quite possible, including federal legislation to create greater accountability in running the VA.
Thomas said that NAAOP continues to advocate for passage of the Injured and Amputee Veterans Bill of Rights (H.R. 3408), which has more than 35 bipartisan cosponsors in the House, including several physicians and nurses now serving in Congress who sit on the House VA Health Subcommittee. Enactment of this legislation would help veterans become their own best advocates to get the O&P services and devices they need, when they need them. Thomas also encouraged NAAOP members to contact their members of Congress and encourage them to finally act to protect and empower VA users of O&P care.
CMS Proposes Prior Authorization for Certain O&P Care
CMS recently announced a proposal to apply prior authorization to certain Medicare claims that are frequently subject to “unnecessary utilization.” Expected to be on this list are certain lower-limb prosthetic components and related billing codes that have been the subject of the Office of Inspector General (OIG) and Comprehensive Error Rate Testing (CERT) reports in the recent past. A Master List will be compiled by CMS using certain criteria that clearly indicate that lower-limb prosthetics will be subject, to some extent, to prior authorization, assuming CMS does not reverse course or Congress does not intervene.
While there is some controversy in the O&P profession as to the relative benefit of prior authorization, a consensus is emerging that there is little in prior authorization that benefits patient care and will likely lead to delays in access to prosthetic care for Medicare beneficiaries. It is not a guarantee of payment, nor will it insulate providers from CMS audits by Recovery Audit Contractors (RACs) and other contractors. The proposed rule is full of policy issues that must be analyzed and addressed, Thoams said, and NAAOP is doing its part to conduct this analysis and seriously engage in this debate.