Tool provides first look at severity of audits

Friday, April 15, 2016

WASHINGTON – Twelve percent of HME claims for new patients, on average, were subject to MAC prepayment audits in the fourth quarter of 2015, according to data collected through AAHomecare’s HME Audit Key.

Drilling down by product category, 22% of hospital beds, support surfaces and manual wheelchair claims were subject to audits, followed by 16% of orthotics and prosthetics, and 14% of respiratory equipment.

“These results are a first step in a comprehensive effort to collect data that demonstrates the burdensome nature of audits, in terms of volumes and overturn rates,” AAHomecare stated in its weekly bulletin.

Nationwide, 78% of providers appealed denials, with O&P leading the way with a 98% appeal rate, followed by ostomy, urological and wound care supplies at 87%.

Upon review, 60% of claims for hospital beds, support surfaces and manual wheelchairs were paid. For O&P and respiratory equipment, 15% and 74%, respectively were paid.

AAHomecare will begin accepting data for the first quarter of 2016 on April 16.

“The HME industry needs reliable and representative data to better demonstrate the burdensome nature of audits,” the association stated. “We must build our capabilities to accurately detail how the industry is being impacted to finally secure much-needed reform to the audit process.”

AAHomecare went live with the HME Audit Key earlier this year. Prior to its launch, the association raised $250,000 to develop the tool.