Industry Scores an Audit Win

Association worked with CMS to change the automatic RAC audits on DME claims related to Part A SNF, hospital stays.

Working collaboratively with CMS, the American Association for Homecare has fixed a key issue related to the automatic RAC Audits on DME claims related to Part A stays at skilled nursing facilities and hospitals.

Automatic RAC audits on DME claims related to Part A stays at skilled nursing facilities and hospitals are now limited to claims made on or after April 1, 2015, according to Kim Brummett, vice president of regulatory affairs for AAHomecare.

Speaking to attendees at the association’s Washington Update, held this week during Medtrade Spring, Vice President of Regulatory Affairs Kim Brummett explained how she and her team worked directly with the agency to address the problem.

While DME and related supplies are covered for the entire 30 days of such stays, the automatic RAC audits were going back several years to review these types of claims. But those providers weren’t able to re-file those claims due to the timely filing requirement.

After working with AAHomecare, CMS announced that such audits would be limited to DME claims made on or after April 1, 2015, Brummett related to the Washington Update’s audience, which responded with applause. The news means that while reimbursement for a claim still might be recouped, providers will now be able to re-file the claim within the proper date, thanks to the April cut-off.

While the change comes as considerable relief for many providers, the “win” is compounded by he fact that the association was able to collaborate with the agency to find a solution.

“Essentially, what we were able to do was work with the folks at CMS,” Brummett said. “ … They understood and heard us, and within in a matter of weeks, we have a huge change.”

AAHomecare President and CEO, also speaking a the Washington update, noted that the victory came through slow and steady work with the agency, and making solid arguments based on clear data. But the key is that the association’s regulatory staff, led by Brummett, met with and worked with CMS to make the change happen.

 “Saying, ‘it’s us against them,’ that strategy didn’t work,” Ryan explained. “What’s happening today is that we’re engaging the agency every single day.

“It’s the biggest piece of news as far as regulatory victories go that the industry has had in probably 10 to 15 years,” said Steve Ackerman, president and CEO of Spectrum Medical Inc., and Treasurer of AAHomecare. “Because it was a collaborative win between the industry and CMS realizing that excess auditing is not really necessary to achieve their goals.

“It shows a real good-faith working relationship developing with Medicare, which we haven’t seen in a long time,” he added.

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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