New Audits for New Year

Regions A, B, C recovery audit contractors post new reviews.

HME businesses expected audits to continue to remain a key industry issue as they approached 2014, and three new reviews awaited them as HMEs began the New Year.

Over the winter break, the recovery audit contractors (RACs) for Regions A, B and C posted new reviews to which providers in those regions should conform.

The latest reviews:

• Performance Recovery, the RAC for Region A, posted on Dec. 26 a complex review for automatic external defibrillators. The review covers claims for automatic external defibrillators that were billed without an indication supporting Medical Necessity as described in the NHIC Local Coverage Determination (LCD) L13613 and related article (A23905). The review impacts providers in CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI and VT, and affects claims up to three years old.

More details can be found at (click “sort by date” twice in order to push the Dec. 26 to the top of the listing).

• CGI Federal, the RAC for Region B, posted on Dec. 18 an automatic review for CPAP claims that do not have the required OSA diagnosis. The review subjects CPAP claims with dates of service starting on Aug. 1, 2010 to automatic review and recoupment, and impacts providers in MN, WI, MI, IL, IN, OH and KY.

More details can be found at (like the Performant review, click “sort by date” twice to bring the review to the top of the list).

• Connolly, the Region C RAC, posted a prepayment review on Dec. 3 for claims for Group 2 support surfaces. The audit is looking for claims that do not meet the indications of coverage or medical necessity related to local coverage determinations. The review covers claims within three years of the determination date and impacts providers in FL, TX, LA and NC.

For more information, visit (the review should appear on the first page).

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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