CMS Puts Hold on Audits for HMEs Hit by Hurricane

Agency to tell contractors to suspend audits for providers affected by Sandy.

CMS is issuing a guidance to its audit contractors today to temporarily suspend all audit activity, effective immediately, for a period of at least 30 days for HME providers operating in disaster areas created by Hurricane Sandy in New Jersey, New York, and Connecticut, according to a report from the American Association for Homecare.

Since the storm hit, the association says it has been in constant communication with CMS and its contractors stressing the need for relief so that providers can continue to focus on helping storm stricken patients rather than get bogged down in paperwork, and that the agency needed to ensure timely payments so that providers could meet the needs of Medicare beneficiaries.

The coming guidance from CMS should inform contractors that they shall not send MR additional documentation requests (ADRs) to any providers in New Jersey, New York and Connecticut for a period of 30 days from the issuance date of the technical direction letter.

Also, contractors shall not deny claims from providers in New Jersey, New York and Connecticut for lack of documentation or insufficient documentation for a period of 30 days from the issuance date of this technical direction letter. Claims shall be released for payment and prioritized for post-pay review.

Contractors shall not send ADRs or deny claims from providers in the ZIP codes that have been designated by the Federal Emergency Management Agency as eligible for direct federal assistance for an additional 30 days (i.e., a total of 60 days).

The suspension applies only to counties with FEMA major disaster declarations eligible for direct federal assistance as of Oct. 30 (not counties with emergency or other declarations). Information by state and county is available on the FEMA website. The suspension applies if any part of the ZIP Code falls within the FEMA designated disaster area. Contractors may use contractor-specific coding to segregate these claims.

The affected counties by state:

New York — Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk.
New Jersey — Atlantic, Cape May, Essex, Hudson, Middlesex, Monmouth, Ocean, Union.
Connecticut —Fairfield, Middlesex, New Haven, New London, Mashantucket Pequot Indian Reservation.

Also, all power mobility device (PMD) claims, PMD prior authorization requests, and therapy requests for exception due to the cap are granted administrative relief only in accordance with Section 3.8 of the Program Integrity Manual.

Additional clarification will be provided regarding a potential grace period when a physician, provider, or supplier is required to meet certain timeframes. CMS will reevaluate whether additional relaxation of timeframes is needed.

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on LinkedIn at and on Twitter at @postacutenews.

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