GAO, AAHomecare Discuss Audit Issues

Accountability office meets with association to ask various questions regarding post-payment audit cocnerns.

The American Association for Homecare met with the Government Accountability Office (GAO) Tuesday to discuss the problems HME providers are experiencing due to CMS’s ramped up post-payment audits.  

The GAO, which investigates issues related to the receipt and payment of public funds, is likely to issue a report on audits of Medicare providers later this year.

The office requested the meeting with AAHomecare to answer several questions from Congress regarding several issues:

  • The extent to which CMS has established consistent post-payment claims review criteria across contractors.
  • How CMS determines that contractors’ post-payment claims review criteria are valid and clear.
  • To what extent CMS prevents duplicative post-payment claim reviews.

“During our discussion, we highlighted the key areas that create so-called ‘errors’ that lead to the denial of claims,” said Walt Gorski, AAHomecare vice president of Government Affairs. “We hope that by working with the GAO, Congress, CMS, and CMS contractors we can fix the problem areas.”

Other major concerns that were identified and discussed were the clarity of contractor communications, consistency of decisions among contractors, and retro-application of policies; and the need for CMS to provide clear, straightforward guidance to physicians about what documents they need to supply to HME providers. The issue of pre-payment audits were also discussed, even though they weren’t specifically mentioned in the GAO objectives.

“This was an excellent opportunity to educate policymakers about HME and the audit concerns we face,” said Rachel Prager, AAHomecare manager of Regulatory Affairs. “We felt that the GAO staff was engaged and very interested in the information we presented.

About the Author

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

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