Reporter’s notebook: Audit reprieve a ‘confidence builder’

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Monday, August 28, 2017

MODESTO, Calif. – It’s not every day that HME providers get good news from a CMS audit contractor, but Home Oxygen Company recently got a break from certain audits.

The provider recently received word from Noridian, the Jurisdiction D MAC, that it had earned 12-month reprieves from widespread prepay reviews for both oxygen and CPAP.

“It’s a confidence builder,” said Andrea Ewert, CEO. “We are doing what they like, and we are going to keep it up.”

Ewert plans to use the reprieve as a chance to further educate her referral sources. Like many providers, Home Oxygen Company says it competes with providers who aren’t such sticklers for documentation.

“Our competitors take anything and everything,” she said. “Now, we can show our referral sources the letter and say we are doing what we are supposed to do.”

Consultant Andrea Stark says such reprieves aren’t the norm, but for certain product categories that are targeted for constant review, like oxygen and CPAP, if providers consistently get their documentation right the first time, it is a possibility.

“Too few suppliers embrace the fact that we want first-pass rates,” said Stark, a reimbursement consultant with MiraVista. “Providers bake into their protocol, intentionally or unintentionally, ‘We just have to get it done and if we get denied, then we’ll appeal it.’”

That, Stark says, creates a never-ending audit loop that’s extremely difficult to get out of.

“Everyone should be vetting their orders and only put out product that they feel should be payable and meets the standard,” she said. “Then they can reap the reward of being exempt and having fewer audits over the course of the year.”

Home Oxygen Company received a similar oxygen reprieve about two years ago. Having two concurrently is especially rewarding. Ewert credits her staff—especially those on the front end.

“They get (what we need) upfront and we have a clean process right through billing,” she said.