Audits: Public enemy No. 1

Friday, February 21, 2014

Walt Gorski, formerly of AAHomecare, once told me that audits were a bigger issue for HME providers than competitive bidding.

I’m starting to believe him.

With competitive bidding, providers know, for the most part, what they’re dealing with. At some point, they know if they’re going to get a contract or not, and they know that reimbursement will be X% off the current Medicare fee schedule.

With competitive bidding, providers may not like what they know, but at least they have enough information to make appropriate business decisions, such as exiting certain product categories or Medicare altogether.

With audits, providers know next to nothing. Since audits can be arbitrary, they don’t know if a claim will be denied, and with the recently announced delays in the appeals process (see story page 1), they don’t even know if they have an avenue for recourse to fight denials.

There have been a number of signs recently that audits have overtaken competitive bidding as public enemy No. 1 in the HME industry:

1.) The respondents to a recent HME Newspoll blamed audits in large part for any poor financial performances in 2013. Fifty-three percent of them said at least 20% of their A/R was more than 60 days old last year.

2.) The People for Quality Care (PFCQ), an advocacy group know for its determined fight against competitive bidding, has turned its attention to fighting audits (see story page 4). On twitter, it recently stated, “2014: Let’s take on audits.”

Another sign: The Office of Medicare Hearings and Appeals planned to hold a daylong forum on Feb. 12 to discuss delays in the appeals process, and The VGM Group was rallying stakeholders to attend the forum and visit lawmakers on Capitol Hill the next day. It planned to tweet live updates from the forum with the hash tag #VGMAuditMadness.

John Gallagher, VGM’s vice president of government relations, has a guest commentary in this issue (see next page), where he challenges providers to do their part:

“The time is now to take on audits. We will use the lessons we have learned in the competitive bidding fight to bolster both efforts. To our faithful providers—leaders who have shown so much through the years—it’s time to go to battle again. Our story may not be the celebrity coverage of every day headlines, but darn it, we’re going to make sure it’s heard.”