LEEDer Group Inc.
8508 North West 66th St.
Miami, Florida 33166 USA

Phone: 305.436.5030
Fax: 305.436.0086
E-mail Address: info {at] LEEDerGroup [dot] com

2013-03 Performant Recovery Notice of Issue Under Review - Ankle-Foot Orthosis - JA

Issues Under Review
Issue Details

Issue Name: Ankle-Foot Orthosis – JA
Issue Number: A000222013
Issue Description: Potential incorrect billing occurred when claims for Ankle-Foot Orthoses were billed without an indication supporting medical necessity as described in NHIC Corp.‘s Local Coverage Determination (LCD) L11527 and related article A19806
Type of Review: Complex
State(s) Impacted: CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VT
Provider Type: DME Supplier
Date Posted: March 11, 2013
Date Revised: No Revision
Dates of Service: Claims having a “claim paid date” which is more than 3 years prior to the ADR date will be excluded.
Issue References: Title XVIII of the Social Security Act (SSA): §1862(a)(1)(A);Title XVIII of the Social Security Act (SSA): §1833(3);NHIC Local Coverage Determination (LCD) L11527 for Ankle-Foot/Knee-Ankle-Foot Orthosis;NHIC Article A19806 for Ankle-Foot/Knee-Ankle-Foot Orthosis;Medicare Program Integrity Manual, (IOM) Publication 100-08, Chapter 3, Section 3.3.2, Section 3.3.2.4, and Section 3.4.1.1;Medicare Benefit Policy Manual, (IOM) Publication 100-02, Chapter 15, Section 110.1, Definition of DME;Medicare Program Integrity Manual, (IOM) Publication 100-08, Chapter 5, Section 5.7, Section 5.8, and Section 5.9;Office of the Inspector General (OIG) Report (OEI-02-99-00120), Medicare Payment for Orthotics, Inappropriate Payments, March 2000;