Self-Audit and being Proactive

Posted By: Eric Schwelke CPO LPO on July 7, 2010

Your thoughts and comments are would be appreciated on the following
scenario:

Self audit on claims for Custom knee orthoses for contractures to Medicare
(under most recent LCD) reveals errors where knee orthoses were ordered,
fit, and delivered but no evidence for ambulatory status is included in the
evaluations or notes. Being proactive, practice reviews and calculates
reimbursement to Medicare, and composes letter to Medicare informing them
that as part of the it's ongoing QA procedures, it is issuing a refund for
unsubstantiated (and Paid) claims.

Question:

Do you think this will make practice a target for further auditing by
Medicare? Or do you think Medicare will look favorably on the entity's
ongoing effort to adhere to proper billing procedures?

Eric Schwelke CPO LPO


Consultants to the Prosthetic and
Orthotic Industry

Eric Schwelke CPO LPO
Success in Motion
Direct 917 337 7557
[E-mail Address Removed]

American Board Certified in Prosthetics & Orthotics
Licensed in New Jersey for Prosthetics & Orthotics
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