California Respiratory Provider Catches a Break on Audits

Home Oxygen Company’s president shares how her oxygen and sleep business earned a reprieve on CPAP and O2 audits.

Andrea Ewert, president and CEO of Home Oxygen Company stressed that stem-to-stern employee training was a key reason why Noridian gave her business a 12-month reprieve on respiratory and CPAP audits.

Modesto, Calif.-based Home Oxygen Company recently earned a 12-month reprieve from both oxygen and CPAP audits from Noridian Healthcare Solutions due to successfully responding to inquiries and obtaining favorable decisions.

The respiratory provider processes more than 5,000 oxygen and sleep claims a year in the Golden State’s Central Valley, and this isn’t the first time it has been on Noridian’s widespread respiratory review. Noridian also notified Home Oxygen Company last year that it would not be included on prepayment review for 12 months for CPAP units.

Andrea Ewert, president and CEO of Home Oxygen Company, said that this latest reprieve resulted from a “collaborative effort between teams that result in a clean file,” and shared some of the steps her team has taken to ensure a successful process: 

“First, we take every audit that has failed in the past and use it as a teaching tool during our department and general meetings,” she said. “Not once or twice, but regularly refer to it when we train on the specific topic.

“Second, we have a dedicated person supervising our A/R department that spearheads all responses,” she continued. “She has over 14 years’ experience dealing with Medicare.”

Third, came training. Ewert says the team was failing audits to such a bad degree in 2015 that Noridian actually requested that it conduct a training session with Home Oxygen Company’s staff on CPAP claims, which Ewart called a turning point that put her business on a path to the audit reprieve.

“Fourth, the front end must have key checklists to stay on target for file completion,” she says. “We also have key performance indicators established that review charts prior to billing which is part of our quality process.”

Bottom line, Ewert stressed training for front-end and back-end staff as the fundamental element in avoiding audits.

“We have team meeting training, entire staff meeting training and department meeting training,” she said. “These are weekly. Then, we invite software vendors, manufacturers, Noridian (Medicare) and consultants —physically or virtually — to make time in regularly assisting with sharpening our process. We are continually learning and adjusting our approach then, we will send people out of town for more training.”

About the Author

David Kopf is the Editor of HME Business.

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