Moving the HME Industry Forward

Legislative/Advocacy

Fresh AIR for Audit Woes

July 14, 2014

WASHINGTON, DC – Introduced last week, the Audit Improvement and Reform Act (AIR Act) seeks nothing less than to fix the broken Medicare audit system. Sponsored by Reps Renee Ellmers (R-NC) [pictured] and John Barrow (D-Ga), the bill is designed to increase transparency, education and outreach, and reward suppliers who have low error rates on audited claims.

The AIR Act would apply to all MACs, RACs, and all other contractors performing audits on DMEPOS providers. American Association for Homecare (AAHomecare) officials advise all providers to visit www.FixMedicareAudits.org to download a copy of the legislation, issue brief, and learn how you can support the legislation.
Key provisions in the legislation include:
• Restoration of clinical inference and clinical judgment when evaluating audits. This provision will significantly reduce error rates.
• Requiring the reporting of error rates on audited claims after adjustment for those audited claims that have been overturned on appeal.
• Requiring each audit contractor to establish an education and outreach program that would help providers better understand the regulations and how to document medical necessity for Medicare patients. Funding for these programs will come from 25% of recoupments.
• Allowing HHS to ensure that all suppliers are audited at least once every two years and those with low error rates can be excused from some or all audits during that two year period. DMEPOS suppliers with a 15% or below audited clams error rate will be subject to only 1 claim audit a year.
• Requiring Medicare Contractor transparency and reporting.
• Limiting documentation review periods to 3 years for all Medicare audits.

“An out of control process fueled rampant audits, and then the victims of these audits no longer had an appeals process to challenge the findings,” said Thomas Ryan, president of AAHomecare. “We applaud Reps Renee Ellmers (R-NC) John Barrow (D-Ga) and other sponsors of the legislation for recognizing that something had to be done to protect the rights of providers across the country.”

“With her background as a nurse, Rep Ellmers knows health care and she knows DME,” said Jay Witter, vice president of Government Affairs for AAHomecare. “Rep Ellmers has been an advocate for the HME industry, thanks to hard work from the North Carolina Association for Medical Equipment Services and HME providers in North Carolina. These members built a relationship with Rep. Ellmers and educated her on the issues such as competitive bidding and the out of control audit system that hurts businesses.”

To support the legislation, AAHomecare today launched www.FixMedicareAudits.org. The site brings together the key components of AAHomecare audit reform strategy. These include supporting the AIR Act, the HME Audit KEY audit data collection and reporting platform, and Share Your Audit Story, a place to share stories of how audits have hurt patients and providers.

MESA Gets Seat at the Table
WASHINGTON, DC – When the Senate’s Special Committee on Aging met last week, the Medical Equipment Suppliers Association (MESA) had a coveted seat at the table thanks to a recent letter to the CMS Administrator.

The letter from MESA’s board to Administrator Marilyn Tavenner (with 12 Senators from MESA’s six states cc’d) detailed industry woes concerning competitive bidding and audits. “Sen Bill Nelson (D-Fla) chaired the Select Committee on Aging, and a staff member from that committee asked for more info over the course of three weeks,” explained Liz Moran, executive director of MESA, which represents Arkansas, Florida, Louisiana, New Mexico, Oklahoma, and Texas. “That three page physical letter did get us a seat at the table. We were so fortunate to have the relationship with Walt Gorski [now a private consultant for the HME industry] and Walt was instrumental in crafting the actual testimony.”

Click Here and go to the 55:20 mark to hear Gorski’s testimony.

Letter to the Editor from Van G. Miller Offers Audit Perspective
WATERLOO, IOWA – The founder of the VGM Group pulled no punches in a recent letter to the WCF Courier, declaring that “many of the providers, especially smaller providers, are being put out of business because they can’t sustain their business. Imagine if you were told years after the fact your employer was taking back the pay they gave you because they found someone above you in the company didn’t fill out your paperwork correctly that month. Imagine the hours and hours of work that must go in to defending these post-pay audits years later while you are otherwise struggling to take care of current patients.” Click Here to read the full letter.

Medtrade Preps Multiple Educational Sessions to Deal with Audits
ATLANTA – Members of the educational advisory board for Medtrade have responded to provider woes by scheduling several audit-related educational sessions for the Oct 20-23, 2014, Medtrade, at the Georgia World Congress Center in Atlanta.

Early registration is still in effect, and those who wish to register now can take advantage of considerable savings.
• 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.