Industry attorneys give providers a heads-up

Wednesday, September 30, 2009

From subcontracting to Medicaid audits, a number of legal issues have appeared on the radar screens of industry attorneys. Here's what they say HME providers should be aware of:

Asela Cuervo, Law Office of Asela Cuervo, Washington, D.C.

As if Medicare audits weren't stressful enough. CMS recently told its contractors to give little leeway when it comes to medical necessity documentation.

The new policy has been in the works for a while, but it also addresses concerns raised in an OIG report earlier this year. That report concluded that the error rate for DME claims in 2008 was inaccurate, in part because carriers did not adequately review medical necessity documentation.

"In the past, there was some degree of discretion that a contractor had when making a determination of medical necessity on an audit," Cuervo said. "If they looked at something, and from what they had in their hands they could conclude that it was sufficient to support medical necessity, that was fine. But now they are going to have to be very strict about the documentation. (CMS) wants the (appropriate) documentation."

That means providers must be rigorous about educating referral sources on what documentation is required to support a prescription for DME, Cuervo said.

Jeff Baird, Brown & Fortunato, Amarillo, Texas

He's seeing a rash of Medicaid audits. In part, that's because most state Medicaid offices are broke and looking for money.

"But it is also altruistic," Baird said. "I've talked to enough attorneys and investigators who are truly concerned about how taxpayers' money is spent in their states."