CMS Meeting Offers Audits Update

Virtual edition of Provider Compliance Focus Group shared information on TPE audits and recommendations it made to the DME MACs.

• By David Kopf
• Oct 22, 2020

CMS’s Provider Integrity Group shared information on the status of its Prior Authorization program and audits during a virtual meeting of its Provider Compliance Focus Group earlier this week, according to an update from the American Association for Homecare.

During this edition of the quarterly meeting — which is open to providers of all types and usually held in person — CMS reported that it had recommended DME MACs to exempt suppliers that passed a TPE Round from post-pay reviews that are active today for one year. CMS also stated during the meeting that post-pay reviews are limited to 20 claims per HCPCS code, per NPI, per six-months.

Also, CMS shared some TPE statistics for DMEPOS suppliers: between October 2019 and March 2020, approximately 1,365 suppliers completed Round 1 of TPE; 127 suppliers completed Round 3 of TPE; and 694 suppliers were released from reviews due to education correcting their errors. Blood glucose strips (A4253) are in the top five topics most referred to CMS due to failure to pass Round 3. Of the 335 total referrals to CMS, A4253 accounted for 43 referrals.

AAHomecare underscored that HME providers should know that TPEs are not currently active due to the COVID-19 Public Health Emergency, with DME MACs directed to only conduct post-pay reviews during this time.