Audits threaten providers

Thursday, January 12, 2012

YARMOUTH, Maine - The onslaught of audits shows no signs of abating, according to the results of a recent HME NewsPoll.

Seventy four percent of respondents say they were audited more frequently in 2011 than in 2010.

"Audits have nearly brought us to our knees," said Tom Black, CEO of Mobility and More in Loveland, Colo., who has experienced payment delays of 60 days or more. "This cannot continue or we will be gone."

The majority of respondents say up to 10% of their claims were audited in 2011.

In addition to cash strangleholds created by audits, the process is just plain expensive, say providers.

"We have estimated the extra cost of manpower and consultants to be in excess of $150,000 to get these claims paid," said one provider.

That provider is in the minority when it comes to bringing in outside help: 74% of respondents say they prefer to handle audits in-house, albeit at a cost.

"We've had to dedicate a full-time employee to do nothing but respond to audits," said Joey Graham, director of operations & administration for Pensacola, Fla.-based Gulf Medical Services.

Even though they're dedicating extra resources to handling audits, providers say they just can't respond to each one.

"It is too time consuming to chase down, copy and send the request information," said one provider. "Also, payment is delayed waiting for the audit review."

But for those who do, it often pays off in the form of fewer future audits, they say.

"Initially, the audits were frequent," said Jim Clark, president of Clark Respiratory and Medical Supply in Catskill, N.Y. "We win most of them. We believe our track record is proving us a low risk."



Unfortunately, your are running in place at a brick wall!! It doesn&#39;t matter if you have impeccable records. It doesn&#39;t matter if the good lord above can attest to your impeccable records. You obviously don&#39;t know the rules of these audits. The rules are very simple. "THERE ARE NO RULES"!! For CMS. End of story. Obviously, you have not followed or paid much attention to the "Nichole Medical/Dominic Rotella case currently before the Third Circuit Court in Philadelphia, PA. A Lower Court Judge has ruled that CMS has limitless power and authority to do whatever, whenever and however they want. They need no specific reason to do ANYTHING!! This includes your audits that is why this case is so important. We have a Medicare Appeal Council (MAC) Decision that stipulates the Auditors, Tri-Centurion did not follow the written rules and we asking The Third District Courts to admonish CMS, The Auditors, Tri-Centurion and The Medicare Carrier NHIC holding them accountable for their actions. Further asking Compensatory damages as restitution for their actions. We are asking the Courts have CMS abide by the same rules and standards as the Providers. Will this stop audits know but a victory for The Plaintiffs will hopefully temper the gun slinging your guilty until proven innocent mentality. I would boldly suggest everyone follow and support the case to it&#39;s conclusion. A prevailing conclusion for Nichole Medical/Dominic Rotella will be the only real ammunition the health care industry has on this issue. Legislative DID NOT work, you know 1600 Pennsylvania Avenue is NOT going to intervene leaving only the Courts as a last resort.<br />
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Two years after the original complaint was filed with the Third District Court we are currently awaiting for the date of Oral Arguments. We have the Courtâ&euro;™s ear. They want to hear what we have to say. This has overcome a major hurdle!! This is the farthest anyone or entity has taken this issue for adjudication.

1. Thoroughness: Complete tasks 100% and pay attention to detail. Be willing to â&euro;œgo the extra mileâ&euro; to follow through on audits, run down leads, â&euro;œdigâ&euro; for fraud and abuse. Properly and consistently adhere to standard auditing and investigative guidelines, document all findings and communications, and create a complete audit trail. Respond to all client requests. Let nothing â&euro;œslip through the cracks.â&euro;<br />
2. Communication: With good grammar and form, cohesively & concisely communicate written audit reports and work product documentation. Be able to verbally communicate in a professional & pleasant manner in potentially combative audit situations.<br />
3. Confidence / Self Assuredness: Must be able to handle irritated or irate audit subjects and diffuse tense situations. Must be able to operate in a sometimes-tense environment and still reach objective of completing the audit.<br />
4. Results Orientation: Take the initiative to tweak & redirect efforts in order to make the account successful. Chase down the leads that will yield the greatest degree of fraud and recoveries.<br />
5. Flexibility: Must adapt and be able to handle a changing schedule and ranging responsibilities.<br />
6. Problem-Solver: Must be able to think through complex situations and fraud schemes, and identify the pattern of abuse. Must be able to work independently and get the job done with minimal supervision.<br />

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What Dominic says is true..We too were audited to ruin but found a way to combat the twisted presentation of the facts when faced with being called on the carpet. One auditor in our complaint went so far as to harass the beneficiary to a point of tears and deciding on her own after badgering her for about 40 minutes that we must have been the company that "fraudulently telemarketed" her since we ended up providing the wheelchair in Maine. This beneficiary was able to track down the truth through her husband who documented HE contacted us on her behalf (he&#39;s disabled also) along with other companies for her needs (perfectly legit) and still Tricenturian denied the claim for the telemarketing later claiming she did not have a valid face to face. It&#39;s now going through the appeals process. Patient was seen by her physician who documented in the chief complaint that patient came for eval of power chair also. He also provided 2 physical assessments (our form as well as the CMN form from DMERC fully addressing the assessment). This is making no sense and in a year of relection I hope all the elder voters being "watched out for" by these auditors are taking note. They can harass you but you can&#39;t get a call from us asking if " you are still interested" in the product you asked us about because God knows once you pass 60 you have no wisdom, common sense or even know where the hang up button is on your phone anymore (I have 2 years to go before I am at risk from you suppliers). All in the name of saving Medicare from the extensive "waste" due to fraud? Does it make sense to anyone to save money by making wheelchairs with a 99 year length of need take 13 claim submissions rather than 1 and of course these ZPICs and RACs aren&#39;t costing the taxpayers much because of course they work for minimum wage right? Come on Congress and Senate think it through... the statistics you&#39;re being fed on "fraud" also includes mistakes and billing errors as well that get fixed, resubmitted and appealed and then most of the time PAID! Even the QICs and ALJs are costing us taxpayer money!!! But let&#39;s destroy and industry and reduce beneficiary access in the name of Fraud Crusades...Must be time to retire!