Providers avoid shortened timeframe

CMS had wanted to require them to respond to initial documentation requests in 60 days
Friday, December 20, 2013

WASHINGTON – It looks like the timeframe for responding to initial documentation requests as part of the Comprehensive Error Rate Testing (CERT) program will stand at 75 days.

CMS had planned to shorten the timeframe to 60 days, but Kim Brummett, senior director of regulatory affairs for AAHomecare, confirmed last week that the agency has tabled its plans indefinitely.

“I received word from the CERT coordinator that the change in the timeframe has been placed on hold until further notice,” she said. “We don’t know why.”

The CERT program measures improper payments in the Medicare fee-for-service program. Historically, DME has had a notoriously high rate of improper payments: It was 66% in 2012, representing $6.4 billion of $9.7 billion in claims.

It’s anyone’s guess as to why CMS would seek to shorten the timeframe, but one theory is that it may make providers take the requests more seriously, says Rose Schafhauser, executive director of the Midwest Association of Medical Equipment Services (MAMES).

“One of the issues with the higher error rates is providers not responding to the requests,” she said.

Even if CMS goes ahead with the change eventually, having 15 fewer days to respond to requests shouldn’t be a big deal for providers that collect their documentation up front and, therefore, have it at the ready, says Sylvia Toscano, owner of Professional Medical Administrators.

“It’s only devastating if you don’t have the documentation at all,” she said.

One thing’s for sure: Whether providers must respond in 60 days or 75 days, they should respond, even when the request is for a small-dollar claim, Schafhauser says.

“The error rate just never seems to going down,” she said. “When you look at all the percentages—it reflects negatively on the industry and DME companies.”