Moving the HME Industry Forward


Surviving the Audit Tsunami

September 2, 2013

WASHINGTON, DC – Nearly every HME provider has felt the effects of the audit tsunami, and some have not survived its onslaught. However, there are a number of developments that providers should watch for that may give some relief.

The American Association for Homecare’s Audit Task Force plans to meet this October at Medtrade in Orlando, Fla. The task force will be completing checklists for providers to use internally to ensure Medicare requirements are met. The checklists will also serve as audit trackers. Another item on the meeting agenda is continued refinement of the strategic plan to address various aspects of the audit problem.

The Government Accountability Office (GAO) recently released a report on Medicare audit contractors that resulted from a study requested by Congress. Members of the House and Senate have raised questions about the efficiency and effectiveness of claim reviews by the different contractors including MACs, ZPICs, RAs, and CERTs

GAO found that the contractors followed the same general process for post payment claim reviews, but that CMS has different requirements for each of the contractors. GAO believes that these differences may impede the efficiency and effectiveness of claim reviews and place an undue administrative burden on providers. CMS has accepted the report’s recommendations and has begun to act on them.

AAHomecare met with GAO this past May to provide input for their report. While the agency was focused on post payment audits, the Association used the meeting as an opportunity to discuss the volumes and challenges of prepayment audits.

Heather Boyd is manager of Regulatory Affairs at the American Association for Homecare, Washington, DC.