SMRC and RAC Conducting New Audits

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

The Supplemental Medical Review Contractor (SMRC) and the Recovery Audit Program contractor (RAC) have both announced audits that impact DMEPOS suppliers.

The SMCRC, Noridian Health Solutions, has launched a new audit for surgical dressings. The review impacts claims with a date of service ranging from Jan. 1, 2019 to Dec. 31, 2019.

The audit covers claims for all HCPCS found in L33831 Surgical Dressings: A4649, A6010, A6011, A6021, A6022, A6023, A6024, A6154, A6196, A6197, A6198, A6199, A6203, A6204, A6205, A6206, A6207, A6208, A6209, A6210, A6211, A6212, A6213, A6214, A6215, A6217, A6218, A6219, A6220, A6221, A6222, A6223, A6224, A6228, A6229, A6230, A6231, A6232, A6233, A6234, A6235, A6236, A6237, A6238, A6239, A6240, A6241, A6242, A6243, A6244, A6245, A6246, A6247, A6248, A6251, A6252, A6253, A6254, A6255, A6256, A6257, A6258, A6259, A6261, A6262, A6266, A6402, A6403, A6404, A6441, A6442, A6443, A6444, A6445, A6446, A6447, A6448, A6449, A6450, A6451, A6452, A6453, A6454, A6455, A6456, and A6457.

“Types of surgical dressings include but are not limited to, alginate or other fiber gelling dressing, collagen or wound filling dressing and foam filling dressings,” Noridian noted in its statement. “Surgical dressings are ranked in the top four categories of the 2019 Comprehensive Error Rate Testing (CERT) Improper Payment Report with an associated improper payment rate of 62.8 percent.”

The Recovery Audit Program contractor (RAC), Performant Recovery, has started two new audits, one on Enteral Nutrition Therapy and the other for Parenteral Nutrition Therapy.

The Enteral Nutrition Therapy audit is a complex review and impacts claims with a date of service on or after Sept. 5, 2021. HCPCS codes affected by the Enteral Nutrition Therapy audit include B4034, B4035, B4036, B4081, B4082, B4083, B4087, B4088, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, B9002.

The Parenteral Nutrition Therapy audit is also a complex review and also impacts claims with a date of service on or after Sept. 5, 2021. HCPCS codes affected by the Parenteral Nutrition Therapy audit include B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200.

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