Providers Need to Learn About Key Audit Changes

Webinar from senior Van Halem Group expert Kelly Grahovac to identify new audit trends, and explain how providers should prepare.

• By David Kopf
• Apr 28, 2016

Several key audit developments that providers might not expect are coming, and providers must know how to prepare, according to industry audit expert Kelly Grahovac, senior consultant for the The van Halem Group.

Grahovac is hosting “Audit Trends: Hot Topics and Expectations,” a May 10 webinar that outlines several new audit trends and changes, as well as how HME providers should prepare. In fact, not knowing what changes are coming could have serious consequences.

“The biggest risk DME suppliers are facing today are the penalties currently being enforced by the ZPICs and PSCs,” Grahovac explains. “Suppliers are looking at suspensions and revocations at a much higher rate than ever before, all due to recent changes in legislation.”

An increased frequency in Medicare claims audits changes has developed just during recent years, according to Grahovac, who has nearly 10 years’ experience at one of the nation’s leading Medicare contractors, where she worked for the Durable Medical Equipment Regional Carrier (DMERC), Qualified Independent Contractor (QIC), and A/B Medicare administrative contractor (MAC). 

“It’s really been in just the last four to five years that we have seen frequent changes in the Medicare audit world, to be more specific, since the implementation of the RACs,” she explains. “With that implementation came such a large influx of audits that CMS and HHS have been pressured to create ‘workarounds’ to relieve the burden on OMHA, in terms of pending ALJ cases.

“Prior to the RAC implementation DME Suppliers experienced audits, but they mostly came from CERT and the DME MACs, with far less penalties than Suppliers are seeing now,” she adds.

On the whole, providers must strive to increase their  “audit awareness,” according to Grahovac, who says providers should aim to be proactive in their anticipation and preparation for audit changes.

“The truth is, most suppliers have some degree of awareness that audits are happening,” she says. “The problem is that like so many other areas of life, it doesn’t become an issue until it’s knocking on your door. And at that point, it’s probably too late.

“There are several suppliers that I have met at conferences and industry meetings that are actively working to be ‘audit ready’ at all times,” she adds. “It’s the other half that aren’t prepared when the auditor comes knocking that add to our industry’s high error rate. And as long as the error rate is high, the audits will not stop. I think there is always room for improvement in terms of staying informed.”

Grahovac  urged providers to attend the webinar to stay on top of several key audit developments.

“There is real value in taking one hour from your schedule to gain insight into the issues affecting your industry,” she advises. Spending that hour with me will give attendees information on changes in legislation, updates to the appeals process, and also a look into the future of audits and the effects this all has on their business. Invaluable information at a valuable price! Who doesn’t love that?”

“Audit Trends: Hot Topics and Expectations” starts at 11 a.m. Pacific / 1 p.m. Central / 2 p.m. Eastern on May 10. Registration is value priced at $89, and providers can sign up at https://hme-business.com/webcasts/2016/05/audit-trends.aspx.