Shift your mindset about audits

Thursday, October 22, 2015

ATLANTA – Audits strike fear in the hearts of many providers. But at Medtrade in Atlanta, in a session titled “Avoid being hit with one of the most powerful arsenals in Medicare’s fight against improper payments - Audits!,” Sharon Briggman, director of training & compliance at the Prometheus Group, will offer pointers that actually designed to make providers view audits as an opportunity, not a threat.

HME News: What’s the pain that audits can inflict on an HME provider’s billing and collections?

Sharon Briggman: I actually think that when a provider gets an audit from Medicare, it’s an opportunity for them to show they’re one of the ones doing it right. It’s their chance to shine and demonstrate that they understand the policies.

HME: Do you see audits increasing or decreasing in the future?

Briggman: I definitely see them increasing, particularly pre-pay audits, because of data mining that can identify trends throughout the provider community. For example, if CMS’s analytics show there has been an increase in billing for wheelchairs, that raises red flags. Why the increase? 

HME: How are prior authorizations changing the billing and collection process?

Briggman: It’s having a significant impact, but suppliers like the process, as well. Medicare is able to better protect the Trust Fund, and providers have reassurance that the item is meeting a medical need.

HME: What’s the one thing you hope attendees learn from your session?

Briggman: That Medicare and the audit process isn’t going to go away. There is a certain mindset providers need to assume—that audits actually are good. If they fail the audit, that shows them where they need to make changes.