Audits


Observation Deck

The Audit Increase HMEs Can Expect in Coming Months

RAC Audits Will Now Account for Product Volume

Requests for additional documentation will be based on the number of claims a provider has in a category.

abstract covid virus graphic

Business Solutions

15th Annual Big 10

Once again, we proofile 10 trends that will shape the HME industry this year. The far-reaching impact of Covid-19 is undeniable, but it’s not the only factor that will define 2022.

Problem Solvers

Assessing CMS's Audit Ramp-up

Providers will see an increase in claims audits from Medicare and other funding sources in 2022. Audit expert Wayne van Halem offers insights into what they can expect for this year.

Podcast

Prepping for CMS’s Audit Ramp-up

Providers will see an increase in claims audits from Medicare and other funding sources in 2022. Audit expert Wayne van Halem offers insights into what they can expect.

SMRC and RAC Conducting New Audits

Both audit program contractors have announced new audits for surgical dressings, enteral nutrition, and parenteral nutrition.

Observation Deck

Preparing for the Next Surge in Claims Audits

With the COVID-19 audit pause well behind us, multiple indicators show CMS is quickly resuming audits in a big way. What do HME providers need to know?

Observation Deck

Preparing for the Next Surge in Claims Audits

MACs’ Post-payment Review Broadened

MACs may now conduct post-payment medical reviews of items and services with dates of service after March 2020.

The Return of Medicare Claims Audits

Several months ago CMS threatened it would resume its claims audits. Now that is happening and audit expert Wayne van Halem provides the details on what’s happening and what providers need to know.



ALJ Appeals Backlog Continues Decline

OMHA reports to AAHomecare that within a year, the number of pending DMEPOS appeals fell by 51 percent.

CMS Meeting Offers Audits Update

Virtual edition of Provider Compliance Focus Group shared information on TPE audits and recommendations it made to the DME MACs.

Observation Deck

Return of the Audits

CMS's announcement that audits would resume Aug. 3 was a shock. Then CMS said it would phase audits back in. What are the details?

Surgical Dressing and Knee Orthosis Codes Could See Post-Pay Reviews

The review from CGS is the result of errors and high payouts for four codes, and should impact claims filed prior to the COVID-19 PHE.

Medicare Claims Audits: They’re Ba-aack

Audit expert Wayne van Halem joins the HME Business podcast to discuss how CMS will phase its audits back in, and how providers should prepare.

Observation Deck

Return of the Audits

The news that CMS planned to resume audits by Aug. 3 took many by surprise. Then CMS said it would resume audits in a phased approach. What are the details and what can providers expect?

CMS: Audits Won’t Fully Resume on Aug. 3

After AAHomecare shared industry concerns over audit resumption, CMS provided a more nuanced and detailed description of how the audit programs will recommence.

CMS to Resume Medicare Audits, Prior Authorization on Aug. 3

Postponed since March 30, TRP, SMRC and RAC audits will restart next month, as will prior authorization for PMDs and support surfaces.

Coronavirus

Business Solutions

Pandemic!

As epidemiologists and public health officials first started warning about COVID-19, some HME providers were already making plans. How has the industry responded to the public health emergency? How have these changes impacted their businesses and patients? How has public policy adjusted? How might all these changes impact the future of the HME?

HMEB Podcast

Diving Into COVID-19 Regulatory Changes

In addition to the $30 billion COVID-19 relief fund, HME providers have seen a cascade of Federal and state regulatory changes, as well as new private payer funding guidelines. AAHomecare regulatory and payer relations experts Kim Brummett and Laura Williard take a deep dive into all of them.

Reassuring Retail HME Customers During Tough Times