To the rescue: The Audit Team

Thursday, March 24, 2011

What separates Canton, Ohio-based The Audit Team, a new group of consultants that helps home medical equipment providers prepare for, fight and win audits, from the rest of the pack? First-hand experience, they say.

Since 1989, Rick Worstell has owned and managed several HME companies and over the years he has developed a tried and tested audit strategy, he says. Want proof? In the past few years, he and his team have appealed about 500 denials for power wheelchairs alone and theyve overturned all but a handful of them.

We do all of this every day ourselves, said Worstell, president and CEO of Harrington Management Group, which began offering services by The Audit Team to other HME companies in February. We see the end game, because were living the same things as our clients.

In addition to Worstell, The Audit Team comprises Stephanie Morgan Greene, general counsel; and Rochelle Mathys, vice president of billing and reimbursement.

The Audit Teams strategy has three elements, Greene says: intake process review (follow the principle that good paperwork in equals good paperwork out); collection analysis (know, for example, how many of your claims are getting re-billed because your staff keeps making the same mistakes) and audit response (make sure the government is living by its standards).

Something like 88% of providers dont appeal denials, but of the 12% that do, 60% get favorable results, Greene said. We look at every audit as a challenge for money thats rightfully ours.

While some providers may think, I cant afford to appeal a denial, they cant afford not to, Worstell says.

If, in an audit, theyre asking for info on 10 patients and they come back and say were going to approve two out of 10, that means 80% of those claims, in their mind, were not billed appropriately, he said. The next thing you know, youre getting more and more audits. Then youre on pre-pay review. Then you get into an extrapolation situation. Weve heard horror stories.

Plus, using The Audit Team can put fighting audits within the means of most providers, Worstell says. Harrington Management Group offers various optionseverything from a monthly fee to a charge per claim.

Its an affordable option for folks who arent going to hire general counsel or a vice president of billing and reimbursement, he said. They dont need to. Over the years, weve created an extremely tight, systematic approach.