AAHomecare tells Senate: Stop audits until backlog clears

Thursday, March 13, 2014

WASHINGTON –AAHomecare has met with senators to discuss improvements the association wants to see to the audit process. First on the list: stop new audits until a massive appeals backlog is cleared.

Kim Brummett, vice president of regulatory affairs, and Jeff Mastej, chairman of the AAHomecare Regulatory Council, met with members of the powerful Senate Finance Committee today to discuss their list of recommendations, according to a bulletin. 

“AAHomecare remains deeply concerned about the tremendous burden unfair, poorly managed audits have placed on home medical equipment providers,” said Brummett.

The battle to fight audits has gained strength ever since a Dec. 31 memo from Chief Administrative Law Judge (ALJ) Nancy Griswold cited a backlog of 357,000 pending appeals pending, and suspended assignment of hearings for appeals dating to July 15, 2013. It could be at least two years before those appeals get assigned to an ALJ. 

Brummett and Jeff Mastej, chairman of AAHomecare’s Regulatory Council discussed the association’s recommendations with committee members.

The association is drafting legislation for audit reforms.

In addition to halting new audits, AAHomecare recommends CMS: 

•Stop interest penalties until an audit clears all levels of appeals; 

•Stop recoupment/repayment until an audit is through all levels of appeals; 

•Issue guidance to DME MACs to allow for a timely filing override on continuous rental or supply claims;

•Issue guidance to DME Macs to require reopening after a redetermination on a technical denial;

•Evaluate the Qualified Independent Contractor to determine if the step is effective or a stop gap on the way to the Administrative Law Judge;

•Assign greater weight to clinical inference, letting the medical record reflect the patient’s needs and pay for services based on those facts.