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Reporter's notebook: Right hand, left hand

Cover yourself in more ways than one, says Greene

As if the sheer quantity of audits wasn’t enough to contend with, HME providers often have to untangle inconsistencies in regulations and guidance, says Stephanie Morgan Greene, a healthcare attorney who’s executive vice president of business development for AC

CMS revises scope of review on redeterminations and reconsiderations


WASHINGTON – CMS has expanded the limits on the scope of review for redeterminations and reconsiderations to include complex prepayment audits, AAHomecare has announced.

GAO pokes holes in CMS’s MA audit program


WASHINGTON – The Government Accountability Office isn’t pleased with CMS’s progress in recovering substantial amounts of improper payments from Medicare Advantage organizations.

Audits: Use two-tier approach

Q. We received our audit results, which include a large amount of money owed to Medicare based on an extrapolated overpayment! What do we do now?

A. To reduce or remove the extrapolation, you will need to appeal the overpayment determination, addressing both the individual claims reviewed in the audit and the extrapolation itself. Consider this a two-tier appeal process.

Regulatory review: Suspensions, overpayments and exemptions


WASHINGTON – From a regulatory perspective, the first several months of 2016 have brought pain, and a little bit of relief, to HME providers.

Tool provides first look at severity of audits


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.

HIPAA audits could catch providers off guard


WASHINGTON – With the Office of Civil Rights gearing up for phase 2 of its HIPAA Audit Program, HME providers could be doing a better job of protecting patient information, legal experts say.

Audits: Get your strategy

Q. Help! I just received an audit request. What should I do to make this go smoothly?

A. From the moment an audit letter lands in your mailbox, to the day the files are organized and ready to go out the door, it is important to have an audit response strategy.

Audits: Be a bit of a sleuth

Q. Is there any way to know what types of equipment/supplies are being audited before I get the dreaded audit notice?

A. Believe it or not, you don’t have to be a fortune teller to predict what Medicare and its auditors have on their radar, but being a bit of a sleuth won’t hurt. Let me explain.

Audits: Audits on the rise

Q. Is it my imagination or have the last few months brought an influx of audits?

A. It is not your imagination! Aside from your standard DME MAC prepay and postpay audits, three contractors in particular have “upped their game,” so to speak, and the DMEPOS community is certainly feeling the pressure.