No more carte blanche for auditors?

Wednesday, November 21, 2012

WASHINGTON – If the amount of feedback that the Senate Finance Committee has received on how to improve the audit process is any consideration, expect it to push for big changes.

"We received almost 2,000 pages of recommendations in response to our solicitation, so it is taking a while to get through them," said Julia Lawless, a spokeswoman for the committee. "We hope to issue a high level summary before the end of the year."

[See also: Former CMS official: The audit process ‘is not working’]

The HME industry's efforts could also get a boost from other healthcare sectors battling audits. Rep. Sam Graves, R-Mo., introduced legislation in October to improve Medicare recovery audit programs for hospitals. Provisions in the bill include establishing deadlines for completing audits and establishing a fee for contractors to pay in the case of an overturned appeal.

AAHomecare plans to meet with Graves' office this month.

"Many of the provisions included in the Graves bill are right on target, however, right now it's aimed only at hospitals," said Walt Gorski, vice president of government affairs for AAHomecare. "We will work with his office to refine the bill because it does have some key elements that we would think are important fixes for HME providers."

In addition to requesting recommendations from the industry, lawmakers have also asked the Government Accountability Office (GAO) to conduct a study on CMS's oversight of audit contractors and whether the process is working.

"There will be a very close examination as to the effectiveness of Medicare's audits on all types of providers, including HME," said Gorski. "They want to see if the policies are actually working the way they are intended to work."

But if the horror stories are anything to go by, audits are not working, say stakeholders. Problems include providers being put on 100% pre-pay reviews, auditors trying to recoup reimbursements on claims that are several years old and auditors rejecting claims for typos.

"The auditors have been given a carte blanche to go after all these claims," said Wayne Stanfield, president and CEO of NAIMES. "All these companies are doing is capitalizing on the ability to do this so they can make more money."