Moving the HME Industry Forward

Legislative/Advocacy

Audit Key Initiative – Why Do We Need Data?

June 1, 2015

WASHINGTON, DC – For many months/years our industry has voiced concerns over volumes of audits, cost of responding, and financial impact to our companies and our industry. We would all agree the impact of audits has been huge and the cost, in terms of additional staff, resources, and delayed payments, is overwhelming.  

So what is to be done? We must collaborate and share our data on the burdens of audits to show lawmakers and regulators the costs and impact. AAHomecare has been working with industry experts and software development gurus to create a tool that will allow us to do just that. In preparation the industry must set the standard for what is tracked and how it is reported.  

The following questions are important, and many providers can’t answer:  
• #Medicare fee for service patients
• #Claims submitted to Medicare DME MACs
• #prepay audits received
• #prepay audits denied
• #prepay audits paid
• #redeterminations filed
• #redeterminations denied
• #redeterminations paid
• #redeterminations pending decision
• #reconsiderations filed
• #reconsiderations denied
• #reconsiderations paid
• #reconsiderations pending decision
• #ALJs filed
• #ALJs denied
• #ALJs paid
• #ALJs pending decision

How can we expect CMS, Congress, and the medical community to believe our story if we cannot tell it? Yet at Medtrade, state association meetings, and other gatherings with manufacturers, consultants, and suppliers, the main topic of discussion is audits and what we are we doing to fix the problem.

The industry agrees that we need to address the problem, but we need the data. When you look at the time it takes to complete a survey, and you say your staff doesn’t have time, think about the big picture. If you don’t have the time to quantify the impact of audits on your business, then the stage is set for the industry as a whole. It is time to make the time.

See if you can answer the questions above and take the time to go to www.hmeauditkey.org and read the PDF of what it will take to complete the survey. We need ALL of us to make a difference.  

Our goal is to launch this survey in the coming months and we need each of you.

Kim Brummett is vice president of Regulatory Affairs for the American Association for Homecare, Washington, DC.