Audit Key: MAC Prepayment Audits Averaged 12% for New Patients

First round of data from Fourth Quarter of 2015 take first step in documenting impact of audits on HME providers, patients.

MAC Prepayment Audit affected an average of 12 percent of all new patients across several categories, according to results the American Association for Homecare compiled from Fourth Quarter 2015 data collected by its Audit Key program

Other findings from the data:

  • Hospital beds, support surfaces and manual wheelchair saw the highest audit rate at 22 percent, while power mobility experienced a 2 percent audit rate.
  • Seventy-four percent of MAC prepayment audits of respiratory devices and supplies were paid upon review and the rate for negative pressure wound therapy was even higher at 77 percent. 
  • Meanwhile 15 percent of orthotics and prosthetics audits were paid upon review.

Perhaps most indicative of the scale of the audit program’s flaws was the statistic that suppliers appealed 78 percent of MAC prepayment denials nationwide. AAhomecare noted that particular trend underscored why action must be taken to “reduce the ever-growing backlog of audits awaiting consideration at the ALJ level.”

The full results for the first round report are available at http://bit.ly/1TUOIKz, and a recorded online presentation from Kim Brummett, vice president of regulatory affairs for AAHomecare is available at http://bit.ly/1XyEQ8m.

These results are a first step in a comprehensive effort to collect data that demonstrates the burdensome nature of audits, in terms of volumes and overturn rates.  Increased participation in the quarterly Audit Key surveys will provide even better data to help us make the case for reform, and will also help us identify new trends and developments in the audit space.  

AAHomecare is urging providers to participate in the next data submission round for Audit Key, which begins tomorrow on April 15 and covers the First Quarter of 2016. All providers are welcome, and those that did not participate in the initial data submission round can still take part in the survey. Participants simply need to enter their NPIs and respective five-digit zip codes to register and get started at HMEAuditKey.org.

Providers needing help registering or entering their information in the Audit Key system can get it via a contact form at http://www.hmeauditkey.org/Home/Help; emailing support@hmeauditkey.org, or by calling (844) HME-AKEY (844-463-2539). 


About the Author

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

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