Audits spark restructure

Monday, December 22, 2014

MATTHEWS, N.C. – A year after the Affordable Care Act went into effect, Carolina’s Home Medical Equipment reorganized to handle an onslaught of audits. 

“We’ve been pounded all year,” said Frank Trammell, president and CEO. “It’s off the charts.”

Although the increase of audit activity is the driving force behind the November retool, Carolina’s HME also reorganized, in part, to handle a wave of bed and wheelchair business generated from winning Round 1 recompete competitive bid contracts. 

To meet increased demand and streamline the audit process, the Matthews, N.C.-based provider has shuffled several of its current employees into new positions, including Andrew Trammell, who was promoted to vice president and CFO, and created a new post to oversee audit activity and regulatory compliance.

If you think winning a competitive bidding contract makes you immune to audits, Frank Trammell says, think again.

“If anything,” he said, “(CMS) has only stepped up the audits and reduced our capability to appeal.”

In the past, the company simply appealed at the Administrative Law Judge (ALJ) level, winning 100% of their cases. However, with 900,000 appeals and counting in the backlog, Carolina’s HME has had to seek a new business model.

To ensure documentation passed muster, Carolina’s HME hired The van Halem Group, a consulting and auditing firm based in Atlanta, to develop best practices to manage the hundreds of audits they received this year.

“My biggest suggestion to anybody right now would be to make sure that their documentation is accurate and can pass an audit,” said Andrew Trammell. “If you don’t have your ducks in a row, you’re not going to survive.”