Many HME Categories Still See High Overturn Rates

Latest Audit Key survey shows continued appeal determinations in favor of providers for several mainstay offerings .

Appeal determinations continue to favor providers in a variety of key HME categories, according to data collected during the Q1 2017 by the HME Audit Key program.

The latest data, available at http://bit.ly/2sWInEE, shows overturn rates of 68 percent for respiratory products, 77 percent for ostomy, urological, wound care, and diabetic supplies, and 81 percent for NPWT devices and supplies.

Other highlights:
  • Beds and manual wheelchairs are a focus. Thirty-seven percent of hospital beds, support surfaces, and manual wheelchair new patients were subject to MAC prepayment audit, compared to 11 percent for respiratory products and single-digit rates for other major categories.
  • 68 percent of MAC prepayment denials were appealed.
  • 71 percent of completed MAC prepayment audits were paid upon review.
  • 67 percent of completed appeal determinations nationwide were in favor of suppliers.
An American Association for Homecare project, The Audit Key program aims to help the industry better understand the impact of Medicare claims audits, and provide detailed information that helps make the industry’s legislative and regulatory case for reforming CMS’s audit program. So far it has collected six quarters of data.

“While these results are bringing the burdensome nature of the audit process into focus, we need more industry participation to be able to use this data to make our case to CMS and Capitol Hill,” a statement from the association read. “Please support this effort by participating in the next round.”

Providers Urged to Join Next Round

To that end, the next round of data submissions begins July 17. This will cover the time period through the 2nd Quarter of 2017. Providers that haven’t yet taken part, or that have skipped rounds can still submit data.

Registration and participation are free and open to all suppliers, not just AAHomecare members. To register and submit information, visit HMEAuditKey.org. Additional information is available at http://bit.ly/1k18xAv.

Also, submitting data continues to get easier. Providers using Brightree can print a report from their My Files folder to answer many of the operational questions on the quarterly survey. Users can retrieve the report named AAH_Output.csv from the Inbox for the My Files page within Brightree, and then open the report in a spreadsheet program such as Microsoft Excel. Comprehensive guidance for using the Brightree report is available as a PDF or a  Microsoft Word document.

About the Author

David Kopf is the Editor of HME Business.

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