The Medicare audit process and coverage criteria do not work properly. They must be modified in order to reduce their negative impact on home medical equipment providers’ operational and financial resources, and consequently, their ability to continue caring for patients. AAHomecare is concerned that the audit standards used by Medicare contractors are having the following unintended consequences: Eligible Medicare beneficiaries are not receiving medically necessary and covered...

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The industry is pleased to see that Performant Recovery, the DMEPOS RAC, has been approved to add an audit that will look at the underpayment of Group 3 power wheelchair options.  All wheelchair accessories (including seating systems) and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs will be reviewed regardless of modifiers.  This issue recovers the incorrect reductions owed to suppliers for claims for these items for DOS 1/1/2016 -...

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Home medical equipment (HME) suppliers who use Brightree software now have access to a new tool that will make it easier to participate in industry efforts to collect data on Medicare audits.  This tool pulls together much of the data sought for the quarterly HME Audit Key Survey, an initiative supporting industry efforts to advocate on Capitol Hill and at CMS for much-needed audit reform.  The current data collection round, covering information from the 1st Quarter of 2017, opened...

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MORE INDUSTRY PARTICIPATION SOUGHT TO MAKE STRONGER CASE FOR AUDIT REFORM WED, JULY 6, 2016 WASHINGTON, DC Results are in from the most recent HME Audit Key survey. The latest round of results including ADRs from October 1, 2015 thru March 31, 2016, show the following: Preliminary data on MAC prepayment audits shows interestingly high approval rates – based upon the current group of participating suppliers, 69% of completed MAC prepayment audits nationwide, were paid upon...

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The new data submission period, for the 1st Quarter of 2016, is now open. Suppliers can go to HMEAuditKey.org to register; participation is free – you just need one of your organization's NPIs and respective 5-digit zip code to register and get started.   The HME Audit Key survey provides reliable and representative data that clearly demonstrates the burdensome nature of audits, in terms of volumes, overturn rates, and company resources required to...

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1ST QUARTER 2016 DATA SUBMISSION PERIOD OPENS APRIL 15 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,...

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