Top 10 Series

1. Top 10 Series Top 10 Medicare Changes in 2010 Joseph McTernan Director of Reimbursement Services, AOPA

2. Top Ten Medicare Changes in 2010 • Reduction in Timely Filing Limits • Result of Patient Protection and Affordable Care Act (PPACA) • All Medicare claims must be filed within 12 months of the date of service • Claims received after timely filing expiration will be rejected

3. Top Ten Medicare Changes in 2010 • Prosthetic Ultra light Material • L5940 and L5950 • Traditionally used to describe ultra light components other than socket material • Policy updated to indicate that L5940 and L5950 may only be used to describe ultra light material incorporated into the socket • Can now be used when replacing the socket only

4. Top Ten Medicare Changes in 2010 • Knee Orthosis Policy Changes • L1832, L1843, L1845, and L1850 • Knee instability must be documented by examination of the beneficiary and objective description of joint laxity • Varus/valgus instability • Anterior/posterior drawer test • L1810 and L1820 • Covered when the patient is ambulatory and has weakness or deformity of the knee and requires stabilization

5. Top Ten Medicare Changes in 2010 • Height Standards for LSO/TLSO • Published by PDAC • Used to determine if a code meets policy criteria • 5’9.4” for Males • 5’3.8” for females • Based on CDC statistics

6. Top Ten Medicare Changes in 2010 PDAC Review Required for LSO/TLSO Effective July 1, 2010 Essentially all LSO/TLSO products must be reviewed and approved by PDAC Does not apply to custom devices fabricated in-house LSO/TLSO products not found on the PDAC list must be billed as A9270 (non-covered service)

7. Top Ten Medicare Changes in 2010 PECOS Provider Enrollment Chain Ownership System Referring Physician must have an active PECOS enrollment record Effective date has changed many times Currently January 3, 2011

8. Top Ten Medicare Changes in 2010 Therapeutic Shoe Policy Changes Certifying Physician must document the qualifying criteria in the patient’s medical record Provider must conduct an in-person evaluation and an in-person fitting May occur on the same day

9. Top Ten Medicare Changes in 2010 RAC Audits Recovery Audit Contractors Sole job is to identify and recover past overpayments Paid on a contingency basis One RAC contractor for each DME MAC Jurisdiction

10. Top Ten Medicare Changes in 2010 New and Revised Supplier Standards Effective September 27, 2010 Several clarifications of existing Supplier Standards Implementation of Standards 27-30 Retention of documentation for 7 years Prohibition on sharing space Minimum hours of operation Link to Final Rule http://edocket.access.gpo.gov/2010/pdf/2010-21354.pdf

11. Top Ten Medicare Changes in 2010 Health Care Reform Patient Protection and Affordable Care Act Signed into law on March 23, 2010 Regulations have not yet been written Areas of concern Medical device excise tax Effective January of 2013 Medicare fee schedule productivity adjustment Negative adjustment applied after annual update