Deal opens door to more audits

Friday, January 11, 2013

WASHINGTON – Tucked into the “fiscal cliff” deal is a provision that could mean bad things for providers already inundated with audits: the extension of the look-back period.

Effective Jan. 2, the date the president signed the bill into law, CMS contractors can audit claims going back five years instead of three years.

“Even the best providers, the ones who do the best paperwork, are more likely to have issues with those older claims,” said Kelly Wolfe, CEO of Regency Billing and Consulting. “There’s been a lot of educational material and webinars since then.”

In the wake of the deal, Wolfe has received dozens of calls from providers who say they’re already so buried in audits that they’re ready to sell their companies.

That’s no surprise to consultant Sylvia Toscano.

“With the overwhelming volume of audits providers are currently facing, this delivers another blow to the industry,” said Toscano, owner of Professional Medical Administrators. “It’s time for a resolution one way or another.”

Responding to audits and collecting additional documentation is already time-consuming and expensive for providers. That won’t get any easier with five-year-old claims, Toscano says.

“Physicians and practitioners are not going to be extra cooperative when you ask for something from five years ago,” said Toscano.

All providers can do to minimize damage from upcoming audits: Conduct self-audits to make sure claims have the support they need, stakeholders say.

Looking forward, AAHomecare plans to keep a close eye on these audits to make sure CMS contractors are reviewing claims based on the right rules, says Walt Gorski, vice president of government affairs.

“This is going to be a challenge,” he said. “We’ve seen other cases where providers are being audited on claims from three years ago, but they’re applying policies that are in place now that weren’t in place then.”


It won't matter if Auditors follow the rules or NOT!!!   Keep in mind The Third Circuit Court Decision in Philadelphia (The Nichole Medical vs Tri-Centurion case) from September 2012 with Sandra Day O'Connors signature.  Auditors have an "Outer Perimeter Discretion" allowing them to go outside ALL the rules and the statute and NO Medicare Provider as it currently stands can challenge that Decision.