BC Advantage - 2019 Issue 4

PROVIDER COMPLIANCE TIPS FOR ORDERING LOWER LIMB ORTHOSES

PROVIDER TYPES AFFECTED Physicians and other practitioners who write prescriptions for lower limb orthoses BACKGROUND The 2018 Medicare Fee-For-Service improper payment rate for lower limb orthoses was 60.3 percent, representing a projected improper payment more than $235.2 million. REASONS FOR DENIALS  Insufficient documentation errors accounted for 84.7 percent of improper payments for lower limb orthoses for the 2018 reporting period. Additional types of errors included no documentation (0.4 percent), medical necessity (5.8 percent), and other (9.0 percent) for this service.TO PREVENT DENIALS Medicare covers ankle-foot orthoses not used during ambulation...

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