AAH, CMS discuss audits

Thursday, January 6, 2011

BALTIMORE - AAHomecare's audit task force met with CMS officials last week to discuss ongoing concerns with ZPIC audits.

"We believe that, with (some of the audits), there is unfairness for the industry," said Jeff Baird, a healthcare attorney with Brown & Fortunato and task force member.

Prior to the meeting, AAHomecare submitted a 14-page white paper to CMS officials addressing, in particular, pre-pay reviews and post-payment audits. The white paper contained real-life examples obtained from home medical equipment providers and other industry stakeholders.

"I feel that we got the points across, and I think that they understood what we were saying," said Baird. "We didn't agree on everything, but we were talking and, hopefully, we will make some progress."

The industry has been plagued by an onslaught of audits--DME MACs, OIG, CERT, RAC and ZPIC. The ZPIC audits, in particular, have been criticized for being overly aggressive and burdensome, and for operating without oversight.

"The ZPICs are taking 60, 90, and in some cases, 120 days to issue an opinion (on provider appeals)," said Andrea Stark, a reimbursement consultant with MiraVista. "All the while, that money is suspended and it ties up cash flow."

The task force was created last June to develop guidelines for Medicare auditing policies. AAHomecare plans to continue to gather examples of audit problems and meet with CMS again in the future.