OIG to look at Questionable Billing for Off-the-Shelf Orthotic Devices

OIG to look at Questionable Billing for Off-the-Shelf Orthotic Devices

Included in the January 2018 Office of Inspector General's (OIG) Work Plan is an active item titled Questionable Billing for Off-the-Shelf Orthotic Devices. The three off-the-shelf orthotic devices being reviewed are:

  • L0648 Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf;
  • L0650 Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf
  • L1833 Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf

According to OIG, claims for these off-the-shelf orthotic devices have grown by 97 percent and allowed charges have grown by 116 percent. They go on to say the biggest concern is the lack of documentation of medical necessity in patients' medical records.

OIG will be examining factors associated with questionable billing for these three orthotic devices, and will describe billing trends from 2014 to 2016 for these devices. They will be evaluating the extent to which Medicare beneficiaries are being supplied these orthotic devices without an encounter with the referring physician within 12 months prior to their orthotic claim and will analyze billing trends on a nation-wide scale.

This is an excellent reminder about the importance of accurate documentation and ensuring documentation accurately medical necessity in patients' medical records.

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