What We Do

• Consulting and training, educational and compliance purposes on site or remote
• Review and organize medical records. Determine if greater specificity is needed in the documentation
• Uncover the type of denial by Medicare including: Additional Documentation Requests (ADR), Pre-payment probes, Comprehensive Error Rate Testing (CERT) Audit, Recovery Audit Contractor (RAC) Overpayments and stopping Recoupment, and Medicare Administrative Contractor (MAC) denials
• Attorney written appeals for all levels including initial and pre-determinations, Redetermination, Reconsideration, and Administrative Law Judge (ALJ) review
• Monitor Appeal Deadlines
• Prepare legal memorandums and briefs at the Administrative Law Judge (ALJ) level
• Help organize and inform on the process of an Administrative Law Judge (ALJ) hearing
• Provide a regulatory advisor during an Administrative Law Judge (ALJ) hearing

Who We Do It For

• Any Orthotic and/or Prosthetic Company in any of the 50 states and 5 territories

How We Do It

• Medical Records are submitted through either
1. Secure HIPPA Web Portal or
2. by fax or
3. secure email
• Attorney written appeals are faxed or mailed within their designated timeframe to their designated Medicare Administrative Contractor (MAC) or Qualified Independent Contractor (QIC) with jurisdiction


• Allows O&P companies to monitor cash flow
• Permits O&P companies to focus on patient care
• Makes time available that is better utilized through leisure activities once enjoyed

Basic Price Structure

• Pre-payment probes/ADR requests range from $40.00 per claim or 5% over $1,000
• Redetermination and Reconsideration are packaged together
i) Orthotics and Prosthetics are priced separately
ii) Bundled claims are discounted
• Administrative Law Judge (ALJ) level of appeal priced separately

• Additional Documentation Requests
-Fee for Service (pay as you go)
-$40.00 per case or if it's over $1,000 (5%)

• Pre-Payment Probe
-Fee for Service (pay as you go)
-$40.00 per case or if it's over $1,000 (5%)

• Appeal Levels-Redetermination & Reconsideration
i) $75.00 per case
ii) $150.00 for bundle of 3 cases
i) $200.00 per case
ii) $500.00 for bundle of 3 cases

• Appeal Levels-Administrative Law Judge (ALJ)
i) $200.00 per case
ii) $500.00 for bundle of 3 cases
i) $450.00 per case or 5%
ii) $1250.00 for bundle of 3 cases or 5%

©2014 National Orthotic and Prosthetic Appeal Advocates