CMS limits audits of older claims

Thursday, April 23, 2015

BALTIMORE – Wave goodbye to audits of older claims for DME supplied to Medicare beneficiaries during a Part A stay.

After working with AAHomecare, CMS has issued a “technical direction letter” to the recovery audit contractors advising them to limit audits to those claims paid on or after April 1, 2015, the association stated in a bulletin.

“By presenting the facts instead of being guarded, we’re building credibility and trust, and this type of collaborative discussion is the result of that,” said Kim Brummett, vice president of regulatory affairs at AAHomecare. “CMS heard us, and within a matter of weeks, we had a common sense fix that will provide significant relief to suppliers.”

Because the RACs have been auditing older claims, providers have been unable to re-file claims due to the timely filing requirement.

A new process for handling these claims, called an informational unsolicited response, will be implemented for dates of service starting April 1, 2015. As part of the new process, the RACs will automatically compare DMEPOS claims paid to Part A claims. If a DMEPOS claim has been paid where the from date of service is during the Part A stay, the payment will be automatically recouped.

AAHomcare advises providers to monitor their electronic remittance notices and, when a recoupment is made, do research to determine when the patient was in Part A stay and submit amended claims post-discharge if the patient had continued to use the equipment/supplies.CMS limits audits of older claims