Audit Denials Increased 6% from Q4 2015 to Q2 2016

Latest HME Audit Key report shows increase audit activity; AAHomecare urges providers to share their data.

The average percentage of of audits denied nationwide increased 6 percent between the fourth quarter of 2015 and the second quarter 2016, according to the latest results from the latest HME Audit Key survey.

Developed by the American Association for Homecare, Brightree LLC, the VGM Group Inc., MED Group and other organization, Audit Key (www.hmeauditkey.org) collects providers’ audit statistics in order drive the kind of hard numbers and credible data that will help the industry make a strong argument for reforming CMS’s audits and easing the financial burdens those audits are having on providers. Moreover, providers can use the data to benchmark their audit experiences against industry averages.

The latest report covers survey results including ADRs from Oct. 1, 2015 through June 30. Some key findings:

  • 36 percent of hospital beds, support surfaces, and manual wheelchair new patients were subject to MAC prepayment audit.
  • 72 percent of completed MAC prepayment audits nationwide were paid upon review. 
  • The supplier appeal rate of MAC prepayment denial decreased 10 percent nationwide between Q1 and Q2, 2016.
  • 51 percent of completed appeal determinations for respiratory products were in favor of suppliers.

The full report, “Examining the Impact of Medicare Audits on HME Suppliers,” is available at bit.ly/2d5e2NQ.

AAHomecare urged providers to participate in the next data submission round, which starts Oct. 15, and will extend into the 3rd quarter of 2016.

“We need additional supplier participation in the Audit Key program — regardless of the number of audits you are receiving,” a statement from AAHoemcare read. “With wider participation, we will be able to make a better case to policymakers for much needed audit reform measures, as well as increasing the value of the data for industry benchmarking purposes.”  

Providers can learn more and register for the next round at www.hmeauditkey.org.

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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