Senate makes progress toward audit reform

Friday, June 5, 2015

WASHINGTON – It may be broad, but there’s a lot for HME providers to feel good about in the audit bill that cleared the Senate Finance Committee last week, says AAHomecare’s Kim Brummett.

First, there’s what’s not in the bill, namely a fee structure for filing appeals, something that was in the original version, says Brummett, vice president of regulatory affairs.

“The initial conversations on that revolved around deterring those providers who just appeal everything, but obviously we oppose a fee,” she said. “We already feel that we’re in the appeals process to begin with because we feel an error has been made.”

The bill, co-authored by Sens. Orrin Hatch, R-Utah, chairman of the committee, and Ron Wyden, D-Ore., the ranking member, seeks to reform the Medicare audit and appeals process by, among other things, improving CMS’s oversight capabilities of auditors, better coordinating efforts between CMS and auditors to ensure all parties receive transparent data regarding audit practices, establishing a voluntary alternate dispute resolution process, and allowing for the use of sampling and extrapolation to expedite the appeals process.

The devil is in the details for many provisions in the bill, including one to establish a magistrate program within the Office of Medicare Hearings and Appeals for cases with lower costs, $150 to $1,460, Brummett says.

“We do see the value in segmenting out smaller dollar claims,” she said. “When you look at oxygen claims, rendering a decision on that is better than a $100,000 hospital re-admission. But what is the program—an ALJ wannabe? What’s the difference between the two?”

Since the bill is far from final, AAHomecare officials plan to continue working with Kim Brandt, chief healthcare investigative counsel for the minority staff of the committee, to try and further shape the Senate’s efforts. One point they want to hammer home: the ways in which HME providers are different than hospitals and need special concessions.

“A hospital encounter is a one-time hit; for us, it’s the same patient, the same equipment, but different dates of service,” Brummett said. “We’ve had conversations with Kim about how it would be nice to have specific DME language that spoke to related claims and ongoing decisions.”

Next steps for the bill include finalizing the language and submitting it for a score from the Congressional Budget Office.

“It’s high priority, but they haven’t indicated when the legislation will hit the floor,” said Jay Witter, senior vice president of public policy for AAHomecare.