Audits


ALJ Appeals Backlog Continues Decline

OMHA reports to AAHomecare that within a year, the number of pending DMEPOS appeals fell by 51 percent.

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.

Observation Deck

Return of the Audits

CMS's announcement that audits would resume Aug. 3 was a shock. Then CMS said it would phase audits back in. What are the details?

Surgical Dressing and Knee Orthosis Codes Could See Post-Pay Reviews

The review from CGS is the result of errors and high payouts for four codes, and should impact claims filed prior to the COVID-19 PHE.

Medicare Claims Audits: They’re Ba-aack

Audit expert Wayne van Halem joins the HME Business podcast to discuss how CMS will phase its audits back in, and how providers should prepare.

Observation Deck

Return of the Audits

The news that CMS planned to resume audits by Aug. 3 took many by surprise. Then CMS said it would resume audits in a phased approach. What are the details and what can providers expect?

CMS: Audits Won’t Fully Resume on Aug. 3

After AAHomecare shared industry concerns over audit resumption, CMS provided a more nuanced and detailed description of how the audit programs will recommence.

CMS to Resume Medicare Audits, Prior Authorization on Aug. 3

Postponed since March 30, TRP, SMRC and RAC audits will restart next month, as will prior authorization for PMDs and support surfaces.

Coronavirus

Business Solutions

Pandemic!

As epidemiologists and public health officials first started warning about COVID-19, some HME providers were already making plans. How has the industry responded to the public health emergency? How have these changes impacted their businesses and patients? How has public policy adjusted? How might all these changes impact the future of the HME?

HMEB Podcast

Diving Into COVID-19 Regulatory Changes

In addition to the $30 billion COVID-19 relief fund, HME providers have seen a cascade of Federal and state regulatory changes, as well as new private payer funding guidelines. AAHomecare regulatory and payer relations experts Kim Brummett and Laura Williard take a deep dive into all of them.



Genetic Testing and Kickbacks: Lessons for DME Suppliers

A shift in scams run by the types of bad actors involved in 2019’s $1.2 billion orthopedic brace fraud ring has new lessons HME providers should take a moment to understand.

Audits: Expert Shines Light on Worrying New Trends

Top-line audit concern includes HHS OIG adding PAP supplies to Its workplan. Wayne van Halem will discuss several new, worrying audit developments and how to prepare for them in Dec. 11 webinar.

Podcast

HHS OIG Adds PAP Supplies to Its Workplan — Again

Sleep equipment providers risk facing costly six-year lookback audits in this new addition to OIG's workplan. How should they prepare?

GF Health Earns ISO 13485:2016 and MDSAP Certification in U.S. Locations

The medical device manufacturer says the certification will allow for more growth in the market and improved efficiency.

game plan

Business Solutions

A Game Plan for Six-Year Lookbacks

CMS's six-year lookback audits represent a daunting challenge for HME providers, but there are steps they can take to deal with them.

RAC Approved to Audit Diabetes Test Strips

Performant will only review HCPCS code A4253 and claims paid date must be within three years before the Additional Documentation Request.

Wayne van Halem

Provider Strategy

A Scary New Trend: Six-Year Lookback Audits

Understanding another 'new normal' for HMEs from HHS OIG.

Home Oxygen Company Earns Audit Reprieve

California respiratory and sleep provider notches its fourth 12-month break from TPE audits.

Industry Hits Capitol Hill with Full Agenda

AAHomecare facilitates in-person meetings between lawmakers and industry advocates in Washington, D.C.; coordinates virtual fly-in for providers to remotely assist lobbying push.

HMEB Podcast Episode 004 Now Online

Latest installment in HMEB’s quickly growing podcast survey examines breast cancer legislation and six-year lookback audits.

HME Business Podcast