Moving the HME Industry Forward

Legislative/Advocacy

First Round of Audit Key Data Shows New Patients Subject to MAC Audits at 12%

April 18, 2016

WASHINGTON, DC – The results are in from the first round of data collection from AAHomecare’s HME Audit Key.  From the initial survey round, covering Fourth Quarter 2105 data, we find that:

The percentage of Medicare new patients subject to MAC Prepayment Audit averaged 12% across several categories. The Hospital Beds, Support Surfaces & Manual Wheelchair category saw the highest audit rate at 22%; at the lower end of the scale, Power Mobility saw a 2% audit rate.

74% of MAC Prepayment Audits of Respiratory Devices and Supplies were paid upon review and the rate for NPWT was even higher at 77%.  At the other end if the spectrum, just 15% of Orthotics and Prosthetics audits were paid upon review.

Suppliers appealed 78% of MAC prepayment denials nationwide, underscoring the need for action to reduce the ever-growing backlog of audits awaiting consideration at the ALJ level.

You can see the full first round report here, and view a brief presentation about them from Kim Brummett, vice president of regulatory affairs with AAHomecare.

These results are a first step in a comprehensive effort to collect data that demonstrates the burdensome nature of audits, in terms of volumes and overturn rates. Increased participation in the quarterly Audit Key surveys will provide even better data to help us make the case for reform, and will also help us identify new trends and developments in the audit space.

The next data submission round, covering the 1st Quarter of 2016, began on April 15. Even if you didn’t participate in the initial data submission round, you can still take part in the survey. You just need one of your organization’s NPIs and respective 5-digit zip code to register and get started at HMEAuditKey.org.

What kind of information is required? The Audit Key does not require you to submit data on individual claims, but instead seeks cumulative counts of pre and post payment audits and appeal claim outcomes for your three largest product categories under DME MAC, RAC and SMRC reviews.

Your data WILL make a difference! The HME industry needs reliable and representative data to better demonstrate the burdensome nature of audits, both in terms of volumes and overturn rates. We must build our capabilities to accurately detail how the industry is being impacted in order to finally secure much-needed reform to the audit process.

Need more information? Presentations to get you started and enter your data can be found on the HME Audit Key homepage. Additional support is available by contact form, via support@HMEAuditKey.org, or by calling 1-844-HME A KEY (844-463-2539).  If you’ve previously registered, you can retrieve your username/password here.

Register and get started today at HMEAuditKey.org.

Senate Support Grows for Competitive Bidding Rural Relief and Bid Ceiling Fix
WASHINGTON, DC – Your Help Needed for Strong House Introduction. The co-sponsor list for S. 2736, the Patient Access to Durable Medical Equipment Act of 2016, now numbers 18 Senators, with additional names expected to be officially added to the rolls soon.

House champions are still working to generate additional support at introduction.  As we have previously noted, original co-sponsors from the House Energy & Commerce Committee (E&C) would be particularly helpful. You can see the full list of E&C Committee members here, with notations for those who sponsored similar legislation (H.R. 4185) last year.

Of course, our champions will welcome support and cosponsors from every corner of Capitol Hill, so please contact your Representative even if they’re not on that list. You can also see the complete cosponsor list for H.R. 4185 here.

Now that we have a strong Senate bill in play, please make every effort to help build support for forthcoming House companion legislation. While direct engagement with legislators and their staff members is the most effective means to advocate for better public policy for HME, you can also send an email here in support of S. 2736 and House companion legislation.