Task force to auditors: 'Use the same thing and ask for the same stuff'

Thursday, May 5, 2011

ALEXANDRIA, Va. - AAHomecare's audit task force hopes to meet with CMS officials this month to discuss its recommendations for getting auditors on the same page as HME providers.

"Our goal with the auditors is to make sure they are consistent, they are accountable, and that providers understand clearly what is being asked of them," said Walt Gorski, vice president of government affairs for AAHomecare.

AAHomecare formed the task force last year in response to the growing number of audits burdening HME providers.

Members of the task force have taken several local coverage determinations, including those for oxygen, CPAP, diabetic supplies, enteral nutrition, nebulizers and power mobility devices, and come up with recommendations for the documentation requirements that providers must meet to get paid.

"We are going to propose that the carriers, the CERTs, the RACS--everybody--use the same thing and ask for the same stuff," said Kim Brummett, a task force member and vice president of contracting and reimbursement for Greensboro, N.C.-based Advanced Home Care. "For example, they need a valid delivery ticket, that kind of thing."

The task force spent several months collecting examples of audit problems from providers. One problem that kept cropping up: Auditors are overlooking the clinical judgment of the prescribing physician to deny claims for technicalities, even when there is a valid medical need, said Brummett. 

"If the physician writes it on a prescription pad, the (auditor) is saying it's not valid," she said. "Why is that not valid? We can argue all day that the sat level is written on the wrong color piece of paper, but if the patient is using oxygen, and there's a benefit (to the patient) and a prescription, just let it go."

In addition to reaching out to CMS, the task force is reaching out to Sen. Orrin Hatch, R-Utah, with examples of the impact of the crushing volume of pre-pay audits on providers.

The task force also seeks to meet with the Office of Inspector General.