Audits


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.

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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.

DMEPOS Accounts for Half of ALJ Appeals

The number of audit appeal being escalated to ALJs has skyrocketed over the past fiscal year, with DMEPOS claims taking up the lion’s share.

71% of MAC Prepayment Audits Paid After Review

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

Medtrade Session Offers Some Good News About Audits

Oct. 24 presentation from van Halem Group duo will examine the ways in which CMS is changing the way CMS is performing some audits -- some for the better.

Audit Key Survey Deadline Extended to Sept. 11 

Brightree Report is now available for the second quarter 2017 Audit Key data submissions.

VGM, HIPAAwise Partner for Online Compliance Program

VGM’s van Halem Group will work with maker of HIPAA software to offer HME providers a custom HIPAA-compliance program.

Second Quarter Audit Key Deadline Extended to Aug. 25

AAHomecare reminds providers that the survey doesn’t require individual claims data, but rather cumulative totals on specific audit metrics.

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