Moving the HME Industry Forward

Legislative/Advocacy

Audits Under Heavy Scrutiny

August 11, 2014

WASHINGTON, DC – The anecdotes are numerous, and AAHomecare is hard at work collecting stories about how audits have personally affected HME beneficiaries and providers. The information will be used to spread the word to regulatory agencies, industry stakeholders, and Congress.
Click Here to share your story.

Below is a featured sample story from a provider who requested that his name be withheld based on fear of reprisal from auditors:

“We are a very small DME company, locally owned and operated. We had around 250 Medicare diabetic supply patients total! We received an audit of 101 patients from 2011. Yes, 2011, 3 years ago. The doctors do not even know where some of these patients are. This is absurd, we were paid an average of $80.00 for these claims, spent $45.00 to supply, now we have spent an average of $30.00 to respond to each audit. On top of that, we are receiving bills of $40.00 from doctors to supply the notes!

“This is about more than our profit. We have been in operation and Medicare approved since 2005. We have great employees and give great service to our patients. Our owners do not get a salary, I’m just hoping for the sake of our employees and patients that we can keep the doors open. We are barely profitable and the industry as a whole will be destroyed if these out of control audits continue.”

Restart of Recovery Auditor Reviews
On Aug. 4, CMS announced plans to modify contracts with current Recovery Auditors to allow for a limited number of Medicare fee-for-service claim reviews beginning in August 2014. Current Recovery Auditors will conduct a limited number of automated reviews and a small number of complex reviews on certain claims including in a variety of categories including DMEPOS.

This limited Recovery Audit Program restart may continue until the new Recovery Auditor contracts are awarded with sufficient time for an orderly transition; CMS is “hopeful” they will be able to award these this year. The restart will not include the Recovery Audit program improvements that are planned for the new contracts. See earlier CMS updates in the Recovery Audit Program here.

Medtrade Tackles Audits
Scheduled for Oct 20-23, 2014, at the Georgia World Congress Center in Atlanta, Medtrade has scheduled several audit-related educational sessions from which to choose. Sessions include:

Mon, Oct 20, 2014 – 1:30 PM to 3:00 PM
“Breaking Bad” Habits with Your Documentation: How to Create Audit-Proof Medicare Patient Charts
Sponsored by: TeamDME!
Speaker: Bruce Brothis, President, Allegient Billing & Consulting, Inc.
Track: Business Operations

Tue, Oct 21, 2014 – 1:30 PM to 2:30 PM
Face-to-Face in the Real World: How to Comply in Its Current Form
Speaker: Andrea Stark, Reimbursement Consultant, MiraVista LLC
Track: Business Operations

Tue, Oct 21, 2014 – 2:45 PM to 3:45 PM
A/R Management – A Best Practice Approach
Sponsored by: Computers Unlimited
Speaker: Miriam Lieber, President, Lieber Consulting LLC
Track: Business Operations

Wed, Oct 22, 2014 – 8:00 AM to 9:00 AM
Let’s Talk About the Respiratory Audits
Speaker: Ronda Buhrmeser, Reimbursement Specialist, VGM Group
Track: Business Operations

Wed, Oct 22, 2014 – 10:30 AM to 11:30 AM
Lessons Learned: Audits and Appeals, How They Affect Bracing
Speaker: Linda Collins, Director of Market Access, Ossur Americas
Track: Business Operations

Wed, Oct 22, 2014 – 2:45 PM to 3:45 PM
Putting the Brakes on a Medicare Audit: Learn What You Can Do To Minimize Your Exposure
Speaker: Mary Ellen Conway, President, Capital Healthcare Group
Track: Business Operations

Thu, Oct 23, 2014 – 9:00 AM to 10:00 AM
Medicare Rules and Regulations: Making Them Work for You
Speaker: Kelly Grahovac, Senior Consultant, The van Halem Group, LLC
Track: Business Operations

Thu, Oct 23, 2014 – 10:15 AM to 11:15 AM
To Bill or Not To Bill – Handling AR For Ongoing Rentals During Audits
Speaker: Stephanie Greene, Cheif Consulting Officer, ACU-Serve Corp.
Track: Business Operations

Thu, Oct 23, 2014 – 10:15 AM to 11:15 AM
Internal Audits: Developing an Effective Plan
Speaker: Wayne van Halem, President, The van Halem Group
Track: Business Operations

Power Lunch
Wednesday, October 22
11:45 am – 1:15 pm
Sponsored by VGM and produced in cooperation with Capital Healthcare Group
Fuel up on lunch and information on one of eight topics crucial to making your business survive and thrive. Grab your included boxed lunch and head your pre-selected table where the moderator will kick-off your roundtable group discussion. Learn from experts, hear from your peers, and take back solutions to your office. Tickets are available through registration and you will have your choice of 1 of 8 topics: Retail Marketing, Legal, Software, Home Accessibility, Audits, Web Marketing & Social Media, Regulatory Updates, or Market Intelligence. Space is limited so sign up early!

The audit-related topic is entitled Everything You Ever Wanted to Know About Audits and More
Facilitators are Denise Leard, attorney, Brown & Fortunato, P.C. and Wayne van Halem, president, The Van Halem Group

Providers who wish to register for Medtrade should CLICK HERE.    
• The full link for registration is http://registration.experientevent.com/showmth141/default.aspx?flowcode=att
• Pricing for events can be found at https://www.medtrade.com/attendee/pricing.shtml

Exhibitors have already bought 95% of the floor space at the Georgia World Congress Center in anticipation of what could be the most important Medtrade in the event’s long history. For a complete list of exhibitors and/or additional information about the show, visit www.medtrade.com.