Think you won't get audited? Think again

Wednesday, March 3, 2010

If you think your company won't get audited, Jeanie Lane would like to give you a dose of reality: "It's not a matter of if they're coming, it's a matter of when they're coming," she says. But providers need not live in fear. Lane, a reimbursement and compliance consultant, identifies some practices that can make an audit less painful.

HME News: How frequently do HME providers get audited? Is it becoming more common? Jeanie Lane: Audits are increasing every day. For a long time, the government didn't have any money to do audits. Now the enforcement is there and it's getting stronger every day.

HME: In an audit situation, what's the worst thing a provider can do?

Lane: When you're facing an audit, it's too late, but they're taking a real risk by not getting the medical records before they bill the claim. I did an audit for a company and they either couldn't get the medical records, the documentation was not there or it was not correct. Medicare would have taken the money back.

HME: What's the best proactive thing a provider can do?

Lane: They should assign someone to monitor the e-mails from the DME MACs every day so they know what is required or what is no longer acceptable.

HME: What's one obstacle a provider faces when he's audited and how does he overcome that obstacle?

Lane: An auditor could question 300 claims and they may only give providers 30 days to get the information together. If providers don't collect the records up front, it can be a very difficult process.

HME: What are some policies and procedures providers should have in place to prevent or better prepare themselves for audits?

Lane: Do in-house audits on a quarterly basis and external audits at least once a year. Assign someone to monitor all of the updates from the DME MACs, CMS and NSC.

Jeanie Lane is a consultant for The MED Group on reimbursement, compliance and external audits. Reach her at 601-829-4769 or