RACs mistakenly rescind some audits

Friday, August 2, 2013

BALTIMORE – Talk about a clawback. Some recent letters rescinding certain audits were sent in error, say stakeholders.

What happened? Some providers apparently received letters from the DME MACs rescinding certain audits on power wheelchairs, support surfaces and prosthetics. 

Unfortunately, that was only partially correct.

“The intent was that they meant to send out rescinds on certain power mobility, but they accidentally sent it on O&P and some other stuff,” said Wayne van Halem, president of the van Halem Group, a consulting firm. 

van Halem reached out to CMS after getting numerous calls from clients asking about the letters.

Essentially, CMS limited the look-back period on power mobility claims to the last 12 months. The change was made so that the timeframe for mobility claims in non-demo states being reviewed parallels that of claims being reviewed in the seven states included in the power mobility demonstration project. The demonstration launched in September of 2012.

It’s disappointing that CMS didn’t limit the look-back period across-the-board, say stakeholders.

“We think that all audits related to claims with a date of service prior to August 2011 should be cancelled,” said Tom Fise, executive director of the American Orthotics and Prosthetics Association.

At any rate, with pretty much all home medical equipment undergoing intense audit scrutiny, industry stakeholders are working to address the issue. AAHomecare recently resurrected its Audit Task Force, and The VGM Group in July launched Speak4DME.com, an initiative to collect written and video testimony from providers about the impact audits have on patient care.

“Our goal is to create a national report of audit problems, based on stories we are receiving from members, to be presented to key congressional committee leadership and CMS later this year,” said Ryan Ball, director of state policy for VGM & Associates.