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AAHomecare: Senate Finance Committee Learns that Medicare Audit Problems are Widespread

WASHINGTON, March 14, 2014 /PRNewswire-USNewswire/ -- Yesterday, Kim Brummett, AAHomecare's vice president of regulatory affairs, attended an invitation-only roundtable meeting with Senate Finance Committee staff. The meeting was called as a follow-up to the Office of Medicare Hearings and Appeals meeting in February about delays in scheduling appeals at the administrative law judge (ALJ) level.

"Kim's depth of experience in dealing with audits when she was a provider, coupled with the inroads she has made at CMS since coming on board at AAHomecare made her the perfect choice for this roundtable," said Tom Ryan, AAHomecare president. "The Committee's staff recognize her as an expert, and we're extremely pleased to have had this opportunity to work more closely with them."

AAHomecare was the only association included in a group that consisted mainly of hospitals. The group shared stories of the burdens that audits have placed on providers, suggestions to improve the audit process, and ways to clear up the enormous ALJ backlog.

"It was interesting to hear that regardless of provider type, the issues were the same," said Brummett. "DME providers are definitely not alone in these difficult times."

AAHomecare emphasized the following points in the meeting:

Main Sources of Audit Burdens

  • Main issue for DME providers are MAC pre-pay audits
  • Auditors are inconsistent and subjective on denials
  • Overlapping of auditing entities

Solutions to Alleviate Audit Burdens

  • Ensure qualified professionals are hired to perform audits
  • Provide feedback on denial reasons at the pre-pay level
  • Bring back clinical inference
  • Waive timely filing rules when claims are caught in the audit process
  • Establish clear guidelines for audits and follow them 

Solutions to Alleviate ALJ Backlog

  • Require MACS to reopen after redetermination on technical denials
  • Stop recoupment until appeals process is exhausted
  • Stop charging interest until appeals process is exhausted
  • Need for payment predictability
  • Separate technical denials and pay providers
  • Separate complex denials and settle for a percent of value with providers 

Kim Brandt, chief healthcare investigative counsel for the minority staff of the Committee, asked participants to email her examples of and data on audits including: how many audits have been performed over a three-year span, how many hours are spent responding to audits vs. patient care, and who is requesting the audits. This information is due back to her no later than April 16.

AAHomecare will provide comments and continue to follow-up with the Committee on next steps.

The American Association for Homecare represents durable medical equipment providers, manufacturers, and others in the homecare community that serve the medical needs of millions of Americans who require oxygen systems, wheelchairs, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org.

SOURCE American Association for Homecare

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