HME NewsPoll: Auditors aren't finding that many overpayments

Thursday, June 10, 2010

YARMOUTH, Maine - HME providers are getting audited on everything from canes to power wheelchairs, but many feel Medicare and its multiple contractors are wasting time and money.

"Diabetic supplies were audited for a beneficiary testing once a day who had been receiving supplies for almost 10 years," said one provider in response to the July HME NewsPoll. "Having to produce doctor's office notes for this was a poor use of my time, the auditor's time and the physician's time."

Poll respondents were evenly split on whether they had been audited so far this year. For those that have, the number of audits varied: 67% of poll respondents have been audited five times or less; 12% have been audited 6 to 10 times and an unlucky 20% report being audited 11 or more times.

An audit can put a severe strain on company finances, providers say.

"We are on 100% prepayment, which means that everything we bill Medicare is audited from canes to ventilators," said one provider. "It is obviously putting a severe strain on our cash position."

Poll respondents reported being audited mostly by CERT, RAC and the ZPIC. While some described the experience as relatively painless, others said that auditors seemed unqualified.

"After reviewing some of the determinations made by the ZPIC, you can tell that they have someone looking at records who does not really know what they are looking at," said one provider.

When providers are audited, what are contractors finding? Not as many overpayments as you might expect. Nearly two-thirds, or 66%, of poll respondents said no improper payments were found. In many cases where overpayments were found, providers were fighting back.

"Non-stop pre- and post-payment audits for power mobility are continuing for the entire industry," said Doug Harrison, president/CEO of The Scooter Store. "We see nearly 100% denials at 'audit' but we are winning virtually 100% in the administrative appeals cycle."

Whether it's all claims, or just one, providers appear prepared to stand by their documentation.

"A claim was pre-pay audited for K0823 and denied initially," said Kevin Jones, CEO/president of All American Medical Equipment in Oklahoma. "The claim contained everything Medicare is looking for. We are expecting an ALJ hearing and looking forward to getting this claim approved. We expect full payment plus interest. An apology from Medicare would be nice, too."

Audits or no audits, Medicare's increasingly onerous documentation requirements, coupled with lower reimbursements, has at least one provider throwing in the Medicare towel.

"We are in the process of notifying the National Suppliers Clearinghouse that we are giving up our number," he said. "So long, Medicare. We are out of here."