When Congress approved the Benefits Improvement And Protection Act of 2000 (BIPA), Orthotic & Prosthetic suppliers were required to be certified in order to receive reimbursement for Medicare services. However this never happened. Medicare and Medicaid patients to this day still continue to be susceptible to substandard care and the industry is still vulnerable to fraudulent payments. H.R. 1958, the Medicare Orthotics and Prosthetics Improvement Act of 2011 is designed to remedy the shortfalls of prior legislation.
Representative Shelly Berkley (D-NV) and Glenn Thompson (R-PA) are the pair responsible for introducing this much needed fix.
"Our legislation seeks to improve care for patients with orthotic and prosthetic devices and to ensure they are receiving treatment from those who are best suited to address their particular medical needs. At the same time, our bill will save money by cracking down and ending fraudulent payments through Medicare," Berkley recently commented.
How will H.R. 1958 strengthen BIPA?
1. H.R. 1958 will protect certified O&P practitioners by enforcing BIPA provisions. BIPA dictated that O&P practitioners must be accredited or certified to receive Medicare payments. This provision has never been implemented. The new legislation will enforce the existing legislation.
2. H.R. 1958 will reduce unnecessary federal expenditures to unqualified suppliers and reduce unnecessary beneficiary co-pays. This is important because under the Medicare Improvements for Patients and Provider Act (MIPPA) which was recently passed many providers became exempt from accreditation.
3. H.R. 1958 will require CMS to report to Congress on its efforts to reduce fraud and abuse. This provision stems from the 2005 Medicare requirement that contractors only pay O&P suppliers that are licensed in states that require licenses. Though the requirement is on the books nothing has ever been put in place to enforce the provision.
