AAHomecare discusses audits with GAO

From: HomeCare Magazine

WASHINGTON, D.C., Jan. 16, 2013—Last week the American Association for Homecare met with the Government Accountability Office (GAO) to discuss the post-payment audit problems that homecare providers face. GAO, which is the investigative arm of Congress charged with examining matters relating to the receipt and payment of public funds, is likely to issue a report on audits of Medicare providers later this year.

The GAO requested this meeting with AAHomecare to answer several questions from Congress regarding the extent to which CMS has established consistent post-payment claims review criteria across contractors, how CMS determines that contractors’ post-payment claims review criteria are valid and clear, and to what extent CMS prevents duplicative post-payment claim reviews.

“During our discussion, we highlighted the key areas that create so-called ‘errors’ that lead to the denial of claims,” said AAHomecare’s Walt Gorski. “We hope that by working with the GAO, Congress, CMS, and CMS contractors we can fix the problem areas.”

A few of the major concerns that were identified and discussed were the clarity of contractor communications, consistency of decisions among contractors, and retro-application of policies. Another point that was emphasized was the need for CMS to provide clear, straightforward guidance to physicians about what documents they need to supply to HME providers. AAHomecare also raised the issue of pre-payment audits even though they weren’t specifically mentioned in the GAO objectives.

“This was an excellent opportunity to educate policymakers about HME and the audit concerns we face. We felt that the GAO staff was engaged and very interested in the information we presented,” said AAHomecare’s Rachel Prager.