Subscribe to RSS - audits


Audits will not resume full bore


WASHINGTON – When program integrity activities resume on Aug. 3, CMS will not be auditing claims started during the public health emergency, industry stakeholders have learned.

CMS reinstates audits, prior auths


WASHINGTON – Starting Aug. 3, auditors will restart their audit functions, according to a recently published FAQ from CMS.

CMS adds CERT to reviews that are suspended


WASHINGTON – CMS will pause its CERT program, and will not send documentation request letters to or conduct phone calls with providers until further notice, according to AAHomecare

AAH reports numerous updates on coronavirus and HME


WASHINGTON – CMS recently updated its COVID-19 FAQ to include coverage for home oxygen for patients diagnosed with the disease.

CPAP supplies: OIG adds another layer of scrutiny


WASHINGTON – Providers who get request letters from the Office of Inspector General for documentation for CPAP replacement supplies need to take them seriously, because there could be a lot of money at stake, say industry stakeholders.

Auditors avoid appeals process, make ‘major’ requests


YARMOUTH, Maine – If you’re an HME provider trying to appeal a denial by a managed care payer, it’s probably not going very smoothly, reports consultant Wayne van Halem.

QIC will transition from C2C to Maximus


WASHINGTON – C2C Innovative Solutions has lost its bid to remain CMS’s Qualified Independent Contractor for HME, according to AAHomecare.

RAC to audit test strips


WASHINGTON – Performant, the national RAC for DME, received approval from CMS on June 14 to audit blood glucose test strips (A4253) nationwide.

Home Oxygen Company earns another reprieve from audits


MODESTO, Calif. – Home Oxygen Company has earned another reprieve from audits for oxygen, due its success ratio of more than 90% in recent audits, the company says.

Advocate at every level


LAS VEGAS - Audits aren't going away, but providers who are proactive vs. reactive will see better results, says Juliet McBride, partner at King & Spalding LLP.