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Reporter's notebook: Audits: Denials, duplicates, delays

Reporter's notebook: Audits: Denials, duplicates, delays

These days, we are hard-pressed to find a provider who doesn't want to vent about audits. From massive recoupments to a two-year wait for an appeals hearing, the system, say providers, is broken.

Right hand, meet left hand

No sooner does provider Glenn Steinke respond to an audit, then he gets hit again—for the same claim.

“Five days after we send the responses, we get a request for the same audit again,” said Steinke, owner of Airway Medical in Bishop, Calif. “We've also had duplicate audits in the same envelope with a different audit number, but with the same date of service, same piece of equipment and same patient. It's a waste of money and time.”

To that end, providers say it's ridiculous that, with the technology available today, auditors can't stop barraging providers on the same claims.

“I refuse to believe they can't put an identifier on a claim to let other auditors know that it's already been audited,” said John Daniel, president of Superior Medical Supply in Clarksville, Tenn., which has about $100,000 tied up in various stages of appeals.

Oh, we changed the rules

The staff at Okeechobee Discount Drugs makes sure to check and recheck its documentation before submitting a claim, but it's frustrating when auditors deny a claim based on changes to the requirements that went into effect years later, says provider Steve Nelson.

“We are fighting them for electric wheelchairs we dispensed four or five years ago,” said Nelson, president/CEO of the Okeechobee, Fla.-based company. “We get all the documentation, and we check and verify. They pay the bill and then they come back five years later and say we don't think she qualified, or we changed the formula in 2011 and now you owe us all this money back to 2006.”

Thank you for holding

These days, providers need to build a plan for dealing with audits into their business models, but with auditors denying on simple technicalities, they can find their hands tied, says provider Carter Fuller.

“We've got a compliance department to make sure we meet the standards and work the appeals,” said Fuller, vice president of business development for Chattanooga, Tenn.-based Professional Respiratory and Medical. “We've appealed about $150,000 worth of claims that we've sent on to the ALJ. We're in a holding pattern waiting on that hearing.”


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