All types of claims are subject to audits every now and then, but some can draw more attention than others. Such is the case for off-the-shelf orthotics, a category that has seen its number of claims double in just the past few years alone. According to the Office of Inspector General (OIG), the charges for these devices have also grown by 116% since 2014, reaching a staggering total of $349 million by 2016. Because of this sudden growth, OIG has decided to begin examining these claims to ensure that Medicare patients are actually going through the proper provider encounter and referral in the year leading up to receiving an orthotic.
In particular, OIG has announced that it will narrow its focus to three specific off-the-shelf orthotics:
- 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-coronal 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 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
These three off-the-shelf orthotics have been found to have inordinately high billing errors rates (sometimes as high as 90%), oftentimes due to the lack of documentation explaining the necessity for these devices. As OIG continues to analyze claims, any practices that bill for these off-the-shelf orthotics should conduct internal audits in order to make sure that all medical necessity is properly documented so that they can correct any errors before it is too late.