Bill caps off weeklong, full-court press on audits

Friday, July 11, 2014

WASHINGTON – Reps. Renee Ellmers, R-N.C., and John Barrow, D-Ga., introduced a bill on Friday afternoon to reform Medicare’s audit program for HME.

H.R. 5083, the Audit Improvement and Reform Act (AIR Act), would require the MACs, RACs and other contractors performing audits to, among other things, reinstate clinical inference and judgment to reduce error rates. In 2009, when this practice was dropped, the error rate for HME skyrocketed from less than 10% of claims to more than 60% of claims, says Tom Ryan, president and CEO of AAHomecare.

“Common sense has been thrown out the window,” he said. “It has just become a matter of the technical components of the billing process.”

Earlier in the week, Sen. Bill Nelson, D-Fla., chairman of the Senate Special Committee on Aging, hosted a roundtable discussion on audits, and the House Oversight and Government Reform Subcommittee on Energy Policy, Health Care and Entitlements held a hearing to discuss the appeal process and potential reform.

Other components of the bill include reducing the document review period for all audits from five years to three years, excluding providers with low error rates from some or all audits during a two-year period, and establishing education and outreach programs for providers.

“A lot of providers have issues because they don’t know what the rules are—CMS is not clear,” said Jay Witter, senior vice president of public policy for AAHomecare. “This would set in stone what they need to do to follow the rules.”

The industry’s next moves include drumming up co-sponsors for the House bill, introducing a companion bill in the Senate and being at the ready when Congress takes up comprehensive reform on audits.

“There has been a lot of political pressure to take action, and this bill gives us the political power to be at the table,” Witter said.

The bill already has strong bi-partisan support from Reps. Bruce Braley, D-Iowa, John Barrow, D-Ga., John Duncan, R-Tenn., and Mike Thompson, R-Pa., according to the North Carolina Association for Medical Equipment Services (NCAMES). The association’s executive director Beth Bowen and members Joey and Billy Tart of Family Medical worked closely with Ellmers to craft and introduce the bill.

In conjunction with the bill dropping, AAHomecare has launched a website,, where visitors can download a copy of the bill and issue briefs, and learn how they can support the industry’s efforts.

“We believe this is doable,” Ryan said.