71% of MAC Prepayment Audits Paid After Review

Second Quarter Audit Key survey releases several significant findings related to Medicare claims audits.

Seventy-one percent of MAC prepayment audits are paid upon review, according to the Second Quarter HME Audit Key survey, which the American Association for Homecare has just released.

Other interesting findings:

  • 11% of new patients are subject to MAC audits
  • 93% of power mobility devices MAC prepayment audits are paid upon review
  • 70% of completed appeal determinations for respiratory products were in favor of suppliers
  • 26% of new patients for hospital beds, support surfaces, and manual wheelchairs were subject to MAC audits
  • 94% of SMRC respiratory audits were targeted at large suppliers 

To get more data, visit the complete 2Q 2017 report at http://bit.ly/2z0Ks5L.

The survey, is used to better understand the audit pressures HME providers undergo as a result of CMS’s various audit programs. Results from the survey are collected into summary reports that the industry users to advance legislation that would rein in CMS’s Medicare program audits.The program is also used to help providers see how their audit experiences are stacking up against other providers.

Bearing that in mind, AAHomecare noted in a public statement that more providers must get involved in the Audit Key program when it returns to conduct its next survey.

“While the results from the HME Audit Key is bringing some light to the burdensome nature of Medicare’s audit and appeals program, we need more industry participation to be able to use this data to make our case to CMS and Capitol Hill,” AAHomecare noted in the statement. “Please support this effort by participating in the next round.”

About the Author

David Kopf is the Editor of HME Business.

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