Meet SMRC, Medicare's newest audit contractor

Friday, May 10, 2013

WASHINGTON – StrategicHealthSolutions, a new audit contractor, has begun targeting claims for post-pay review. The problem, say stakeholders: Many have already been audited.

“There’s only a select pool of providers, and a select pool of claims to pull from,” said Andrea Stark, a reimbursement consultant with MiraVista.

Medicare contracted with the Omaha, Neb.-based StrategicHealthSolutions to serve as a Medicare supplemental medical review contractor (SMRC) in 2012 to “identify and employ more efficient methods of medical review, such as data extrapolation” and lower improper payments for fee-for-service claims, according to its website.

So far, it looks like the contractor is going after sure bets, say stakeholders, like power mobility claims, which typically have high error rates.

“They’re looking for situations where there’s a high likelihood there’s going to be an issue,” said Stephanie Morgan Greene, general counsel for Harrington Management Group, also known as The Audit Team.

Provider Dave Hosemann had just provided requested information on a claim to another auditor when StrategicHealthSolutions requested the same information on the same patient. StrategicHealthSolutions told Hosemann it hadn’t meant to duplicate another auditor’s efforts, but asked him to provide the information, anyway.

“Does the left hand know what the right hand is doing here?” said Hosemann, owner of Vicksburg, Miss.-based Hometown Medical. “I think someone has to make a decision on whether these entities want beneficiaries taken care of or whether they don’t.”

Provider Mark Farmer has also experienced double dipping: Three of the four claims StrategicHealthSolution is currently reviewing have already been audited. That puts even more stress on his staff.

“It’s so labor-intensive to respond to these audits,” said Farmer, president of Mesa, Ariz.-based Southwest Mobility. “They’re relentless.”

The only hope for reducing audit scrutiny is to ensure you have a high approval rate, says Greene.

“Take every audit extremely seriously,” said Greene. “If you pass a random DME MAC audit, the likelihood of another audit is significantly lowered.” HME


My company recently received an audit request from StrategicHealthSolutions for the medical records  on 14 power wheelchair claims, all of which have already been audited by our regional contractor and paid.  Providers cannot even sigh a breath of relief when a power wheelchair is audited and paid before another auditor is knocking on our door asking us to provide the same information once again.  I agree that it is very labor intensive and adds nothing to our bottom line.  I didn't even know this contractor existed until I received  its letter.  If CMS would have done its homework and paid more attention to The Scooter Store years ago when ethical providers could easily see that The Scooter Store was not in compliance with  Medicare laws, CMS would not be hiring all of these audit contractors to try and recoup its losses from The Scooter Store.  Shame on CMS for turning its head away from The Scooter Store when all the signs were there!

Because of the similarities of the name of our company, Scooter Warehouse, Inc., with The Scooter Store of New Braunfels, many times the power wheelchair paperwork from a physician's office that was intended for The Scooter Store, mistakenly came to our company.  It was evident that The Scooter Store medical documentation was not in compliance with Medicare requirements.  Many times I reported this to the OIG, and never received a response to my complaints.

What if StrategicHealthSolutions audits these claims and does not agree with the regional contractor?  Does the provider have appeal rights to an unfavorable decision of  StrategicHealthSolutions?

When will CMS realize that it is not the small provider they need to worry about, as the majority of small providers do care about the beneficiary and do their best  to be compliant.  

Patricia Moore, President

Scooter Warehouse, Inc.

South Bend, IN  




I have the same issue. They audited a claim that was already audited and paid. Its shame that the government is crying about waste and abuse but will pay someone to do the same job twice. I'm just waiting for them to tell me they are denying the claim; at that point Medicare can have their supplier number because it will prove my point that they are the ones scamming providers.