Validation for the audit-weary

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05/12/2011

Last week, I wrote here about what appeared to be some files missing from my medical record. I was annoyed, but figure they'll show up eventually (and yes, I plan to ask at my next visit). To me this was a minor annoyance, but to an HME provider, a similar scenario could result forking back some money.

As Sharon commented:

"If you were a Medicare/Medicaid patient that required DME the provider would not have access to your file in an Audit. This would result in a recoupment and the provider would be held liable for the doctor losing patient data. Another sad scenario is that doctors all too often underchart visits causing the same issues in audits."

Of course, the fact that the paperwork was missing still wouldn't negate the need for the DME, nor would it mean that the DME wasn't provided to me, the patient. It's a simple (I hope) paperwork mix-up that is totally out of the DME provider's control.

I spoke with Kim Brummett, who sits on AAHomecare's audit task force, last week about issues with audits run amok. In addition to a lack of uniformity from auditor to auditor regarding the rules to be followed, and I's and T's to be crossed, the auditors are also quibbling over minutiae. As she so succinctly put it: "We can argue all day that the sat level is written on the wrong color piece of paper." That shouldn't mean that the prescription is not valid.

What is valid is the industry's belief that paying auditors to find mistakes, and turning said auditors loose without oversight, was not a good plan.

Theresa Flaherty

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