|By PR Newswire||
|September 4, 2014 12:33 PM EDT||
WASHINGTON, Sept. 4, 2014 /PRNewswire-USNewswire/ -- A Government Accountability Office (GAO) investigation recently found that the Centers for Medicare & Medicaid Services (CMS) provides insufficient oversight to contractors auditing Medicare reimbursement claims. These inappropriate, multiple audits are crippling the operations of many home medical equipment providers.
The American Association for Homecare (AAHomecare) said the GAO report, which was released earlier this month, underscores the repeated complaints from providers that the rampant out-of- control CMS audit system is placing unfair burdens on their businesses. Read more about this issue and CMS's response to the report in the latest edition of DME Matters: CMS Says It Will Fix Mismanagement Of Medicare Audits
"The GAO report confirms what the industry has been saying for years: the CMS auditing system is poorly managed, is forcing good providers out of business and needs to be significantly revised," said Thomas Ryan, president of AAHomecare. "Hopefully, the GAO report helps create the changes needed to ensure that HME providers can stay in business and supply Medicare beneficiaries with the quality services and products that they deserve."
Ryan noted that Congress is already working on a legislative fix to the audit system. The recently introduced Audit Improvement and Reform Act (AIR Act), H.R. 5083, will increase transparency, education and outreach, and reward suppliers that have low error rates on audited claims. The AIR Act would apply to all contractors performing audits on durable medical equipment, prosthetics, orthotics, and supplies.
The extent of the audit problem was revealed last December when Administrative Law Judges suspended action on new audit appeals because of the backlog of cases. There are now more than 600,000 cases awaiting appeals. Previous to the suspension, providers repaid the government or didn't get paid during the appeals process. But most appeals were ultimately won by providers and they received the money owed for providing home medical equipment to Medicare patients.
But closing down the appeals process left providers with no recourse and has forced many to shut their businesses or no longer service Medicare patients.
Another factor for providers is the amount of time and resources needed to comply with the army of auditors that CMS has unleashed without proper management. CMS has hired a variety of contractors that conduct audits of providers - Durable Medical Equipment Medicare Administrative Contractors (DME MACs), Zone Program Integrity Contractors (ZPICs), Recovery Audit Contractors (RACs) and the Comprehensive Error Rate Testing Contractor (CERTs). And what GAO determined is that these entities are not coordinated and are wasting government resources by auditing the same claims, while needlessly burdening the providers.
"This audit process has done a major disservice to providers and to the Medicare beneficiaries who they serve," said Ryan. "The GAO report is a major rebuke of CMS' ability to adequately manage an audit system and provides further evidence that this is bad public policy must be fixed."
Specifically, the GAO report found that:
- A Recovery Audit Data Warehouse was created to track audits and prevent duplications. But GAO found that the database was not designed to provide information on all possible duplications, and that its data was not reliable because the contracts didn't include the necessary information.
- Contractors had a low compliance rate on requirements that they communicate to providers their rights during an audit. This affected the ability of providers to exercise their rights.
- A lack coordination and oversight by CMS regarding the activities of their audit contractors.
- CMS has not established clear guidance prohibiting contractors from reviewing the same claims.
The flaws cited in the GAO report got the attention of many on Capitol Hill.
"The provider community has raised numerous concerns about the consistency and accuracy of the audit process over the past few years and this report is the first effort to determine what steps could be taken to improve the process," said Rep. Diana Louise DeGette (D-CO). "The information in this report can now be used by Congress and CMS to help make improvements and ensure more consistent oversight of both the contractors and audit process."
Ryan cautioned that the audit legislation won't solve all the problems, but will help.
Read more about this issue and CMS's response to the report in the latest edition of DME Matters: CMS Says It Will Fix Mismanagement Of Medicare Audits (September 2, 2014)
The American Association for Homecare represents providers of home medical or durable medical equipment and services who serve the needs of millions of Americans who require prescribed oxygen therapy, wheelchairs, enteral feeding, and other medical equipment, services, and supplies at home. Visit www.aahomecare.org.
SOURCE American Association for Homecare
SYS-CON Events announced today that Technologic Systems Inc., an embedded systems solutions company, will exhibit at SYS-CON's @ThingsExpo, which will take place on June 6-8, 2017, at the Javits Center in New York City, NY. Technologic Systems is an embedded systems company with headquarters in Fountain Hills, Arizona. They have been in business for 32 years, helping more than 8,000 OEM customers and building over a hundred COTS products that have never been discontinued. Technologic Systems’ pr...
Feb. 24, 2017 05:30 PM EST Reads: 3,326
In his keynote at @ThingsExpo, Chris Matthieu, Director of IoT Engineering at Citrix and co-founder and CTO of Octoblu, focused on building an IoT platform and company. He provided a behind-the-scenes look at Octoblu’s platform, business, and pivots along the way (including the Citrix acquisition of Octoblu).
Feb. 24, 2017 05:00 PM EST Reads: 10,684
How will your company move to the cloud while ensuring a solid security posture? Organizations from small to large are increasingly adopting cloud solutions to deliver essential business services at a much lower cost. According to cyber security experts, the frequency and severity of cyber-attacks are on the rise, causing alarm to businesses and customers across a variety of industries. To defend against exploits like these, a company must adopt a comprehensive security defense strategy that is ...
Feb. 24, 2017 05:00 PM EST Reads: 4,861
In his session at 20th Cloud Expo, Chris Carter, CEO of Approyo, will discuss the basic set up and solution for an SAP solution in the cloud and what it means to the viability of your company. Chris Carter is CEO of Approyo. He works with business around the globe, to assist them in their journey to the usage of Big Data in the forms of Hadoop (Cloudera and Hortonwork's) and SAP HANA. At Approyo, we support firms who are looking for knowledge to grow through current business process, where even...
Feb. 24, 2017 04:15 PM EST Reads: 531
DevOps is being widely accepted (if not fully adopted) as essential in enterprise IT. But as Enterprise DevOps gains maturity, expands scope, and increases velocity, the need for data-driven decisions across teams becomes more acute. DevOps teams in any modern business must wrangle the ‘digital exhaust’ from the delivery toolchain, "pervasive" and "cognitive" computing, APIs and services, mobile devices and applications, the Internet of Things, and now even blockchain.
Feb. 24, 2017 03:45 PM EST Reads: 1,424
WebRTC is the future of browser-to-browser communications, and continues to make inroads into the traditional, difficult, plug-in web communications world. The 6th WebRTC Summit continues our tradition of delivering the latest and greatest presentations within the world of WebRTC. Topics include voice calling, video chat, P2P file sharing, and use cases that have already leveraged the power and convenience of WebRTC.
Feb. 24, 2017 03:45 PM EST Reads: 1,264
A strange thing is happening along the way to the Internet of Things, namely far too many devices to work with and manage. It has become clear that we'll need much higher efficiency user experiences that can allow us to more easily and scalably work with the thousands of devices that will soon be in each of our lives. Enter the conversational interface revolution, combining bots we can literally talk with, gesture to, and even direct with our thoughts, with embedded artificial intelligence, whic...
Feb. 24, 2017 03:30 PM EST Reads: 1,400
Some people worry that OpenStack is more flash then substance; however, for many customers this could not be farther from the truth. No other technology equalizes the playing field between vendors while giving your internal teams better access than ever to infrastructure when they need it. In his session at 20th Cloud Expo, Chris Brown, a Solutions Marketing Manager at Nutanix, will talk through some real-world OpenStack deployments and look into the ways this can benefit customers of all sizes....
Feb. 24, 2017 03:15 PM EST Reads: 1,116
SYS-CON Events announced today that CA Technologies has been named “Platinum Sponsor” of SYS-CON's 20th International Cloud Expo®, which will take place on June 6-8, 2017, at the Javits Center in New York City, NY, and the 21st International Cloud Expo®, which will take place October 31-November 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. CA Technologies helps customers succeed in a future where every business – from apparel to energy – is being rewritten by software. From ...
Feb. 24, 2017 03:15 PM EST Reads: 2,132
Cloud Expo, Inc. has announced today that Andi Mann and Aruna Ravichandran have been named Co-Chairs of @DevOpsSummit at Cloud Expo 2017. The @DevOpsSummit at Cloud Expo New York will take place on June 6-8, 2017, at the Javits Center in New York City, New York, and @DevOpsSummit at Cloud Expo Silicon Valley will take place Oct. 31-Nov. 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA.
Feb. 24, 2017 02:45 PM EST Reads: 1,870
With 10 simultaneous tracks, keynotes, general sessions and targeted breakout classes, Cloud Expo and @ThingsExpo are two of the most important technology events of the year. Since its launch over eight years ago, Cloud Expo and @ThingsExpo have presented a rock star faculty as well as showcased hundreds of sponsors and exhibitors! In this blog post, I provide 7 tips on how, as part of our world-class faculty, you can deliver one of the most popular sessions at our events. But before reading the...
Feb. 24, 2017 02:15 PM EST Reads: 8,482
In recent years, containers have taken the world by storm. Companies of all sizes and industries have realized the massive benefits of containers, such as unprecedented mobility, higher hardware utilization, and increased flexibility and agility; however, many containers today are non-persistent. Containers without persistence miss out on many benefits, and in many cases simply pass the responsibility of persistence onto other infrastructure, adding additional complexity.
Feb. 24, 2017 02:15 PM EST Reads: 907
The best way to leverage your Cloud Expo presence as a sponsor and exhibitor is to plan your news announcements around our events. The press covering Cloud Expo and @ThingsExpo will have access to these releases and will amplify your news announcements. More than two dozen Cloud companies either set deals at our shows or have announced their mergers and acquisitions at Cloud Expo. Product announcements during our show provide your company with the most reach through our targeted audiences.
Feb. 24, 2017 02:00 PM EST Reads: 1,958
DevOps is often described as a combination of technology and culture. Without both, DevOps isn't complete. However, applying the culture to outdated technology is a recipe for disaster; as response times grow and connections between teams are delayed by technology, the culture will die. A Nutanix Enterprise Cloud has many benefits that provide the needed base for a true DevOps paradigm. In his general session at 20th Cloud Expo, Chris Brown, a Solutions Marketing Manager at Nutanix, will explore...
Feb. 24, 2017 01:45 PM EST Reads: 1,103
In his session at @ThingsExpo, Steve Wilkes, CTO and founder of Striim, will delve into four enterprise-scale, business-critical case studies where streaming analytics serves as the key to enabling real-time data integration and right-time insights in hybrid cloud, IoT, and fog computing environments. As part of this discussion, he will also present a demo based on its partnership with Fujitsu, highlighting their technologies in a healthcare IoT use-case. The demo showcases the tracking of patie...
Feb. 24, 2017 01:15 PM EST Reads: 806