Audits


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.

strategy

Business Solutions

Setting a Smart Strategy for 2019

Are you setting the right strategy for 2019? This marks our 11th annual survey of the 10 key trends that will impact the home medical equipment industry the most during the New Year. In this year's list, larger healthcare and retail trends could impact HME more than anticipated. As a result, this installment of the Big 10 list is a must-read.

Editor's Note

Beating CMS to the Punch

DMEPOS represents an outsized share of audit appeals at ALJ. Providers must take action first.

Observation Deck

A Tight Spot

How to approach the CGS/Noridian letter and the '60-Day Rule.'

CMS Expands QIC Phone Demonstration Project

Starting Nov. 1, a demonstration project that lets providers work with QIC over the phone to reopen claims at ALJ will grow to incorporate Jurisdictions A and B.

Sleep Providers Told to Hunt Down, Refund Overpayments

June's HHS OIG report on PAP resupply overpayments has resulted in Medicare contractors asking some sleep providers to review claims going back over six years.



lookout scope

Business Solutions

A Look Ahead For HME

Each October we ask the members of HMEB’s editorial advisory board to share their insights into the trends, obstacles, challenges and opportunities that providers will likely encounter over the next several months. This year, the board members are pointing to several developments that providers might not have on their radars.

A ‘Win’ for Providers: Injunction Against Recoupment of Money

An appellate decision from the Fifth Circuit Court of Appeals offers good news for providers caught in the ‘no man’s land’ between reconsideration and the Administrative Law Judge.

Most PAP Resupply Claims Don’t Pass Medicare Muster

New report from HHS OIG says claims for replacement positive airway pressure device supplies didn’t comply with Medicare’s requirements.

Jurisdiction D Releases TPE Error Rates

Enteral Nutrition tops the list in data gleaned from Fourth Quarter 2017 Targeted Probe and Educate audits.

Home Oxygen Company Earns CPAP Audit Reprieve

Audit contractor Noridian tells provider it has closed its audit file thanks to it squeaky-clean performance in Round 1 of the Targeted Probe and Education Audit process

CMS to Join Heartland Panel Discussion

Attendees to VGM event will be able to discuss regulations, reimbursements and audits with CMS representatives.

AuditKey Offers Sneak Peak at Benchmarking Report

Prototype of the audit survey data shows a variety of ways providers can compare their audit performance to the industry.

Next Round of HME Audit Key Submissions Starts Jan. 15

Industry audit survey will go from quarterly to half-year reports, includes new report benefit.

Problem Solvers

Oxygen Audits in the New Year

What can respiratory providers expect from a new audit program during 2018, as well as respiratory audits carrying over from last year?

Oxygen Audit Outlook: TPE Audits

Audit expert Wayne van Halem explains why respiratory providers need to pay close attention to Medicare's new TPE audits.

Podcast with Dr. David White

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