Bill tries to force CMS’s hand on O&P certification

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Tuesday, May 30, 2017

WASHINGTON – Reps. Glenn “GT” Thompson, R-Pa., and Mike Thompson, D-Calif., have once again introduced a bill that calls on CMS to enforce a law that O&P providers be certified to receive payments under Medicare.

Thompson and Thompson introduced H.R. 2599, the Medicare Orthotics and Prosthetics Improvement Act of 2017, last week. They have introduced similar bills in previous sessions of Congress.

“Medicare beneficiaries in need of prosthetic and orthotic services deserve to know they’re getting the very best care,” said Mike Thompson in a press release. “Keeping fraudulent providers out of Medicare will ensure patients get the treatment they deserve, and has the added benefit of reducing costs.”

The Benefits Improvement and Protection Act (BIPA), which was signed into law back in 2000, requires certification for O&P providers. CMS has failed to enforce the provision, however, resulting in an uptick in fraudulent payments to unlicensed providers, Thompson and Thompson say.

The bill would also link eligibility for payment to the qualification of the providers and the complexity of the device; establish orthotists and prosthetists as Medicare providers, distinguishing them from DME providers; and clarify that notes taken by orthotists and prosthetists should be part of the patient’s medical record.

Congress adjourned late last year without passing the Medicare Orthotics and Prosthetics Improvement Act of 2015.