Hospital audit legislation a model for HME?

From:  HomeCare Magazine

In AAHomecare’s concentrated efforts to reduce the audit burden on homecare providers, the association is carefully examining newly introduced legislation introduced on behalf of hospitals. The legislation contains a number of provisions that would help HME providers keep Medicare payments that they are entitled to for equipment and services furnished to Medicare beneficiaries.

Rep. Sam Graves (R-Mo.) recently introduced H.R. 6575, the Medicare Audit Improvement Act, a bill designed to ease the audit burden for Part A hospital claims. While the bill specifically applies to hospital claims, many of the provisions could be adapted and modified into proposals to address the audit issues plaguing DME providers. For hospital claims subject to audit, the bill would:

• Place a limit across all audit contractors (RAC, MAC, CERT, PSC, and ZPIC) on the number of claims that a provider has subject to audit within a specific time period;

• Establish financial penalties for RACs for failure to meet program requirements;

• Require RACs to pay a fee for denials that are overturned on appeal;

• Require MAC and RAC audits to focus on widespread payment errors, defined as a 40 percent error rate;

• Increase transparency by requiring CMS to publish annual information on RAC audits including denials and outcomes of appeals;

• Allow for rebilling of claims as original, reopened claims for Part B inpatient hospital claims denied based on site of service; and

• Require physician review of RAC, MAC, and CERT denials for medical necessity if a non-physician employee performed the initial review.