Audits spur cottage industry

YARMOUTH, Maine - The “crazy amount of audits” hitting HME providers has created a niche business for industry consultants and billing companies that offer services to help them navigate the process.

The van Halem Group, which has been a player in this business since 2006, has seen the number of additional development requests (ADRs) that some of its clients receive go from about 25 to 300 per month in recent years. It has one large client that receives, on average, 1,000 ADRs per month.

“In the last few years, a lot of folks have moved into the audit business,” said Wayne van Halem, president. “There's a crazy amount of audits, so there's a need there. Providers need help.”

Services offered by consultants and billing companies include everything from collecting documentation from referral sources to reviewing it for compliance to packaging it up for response letters. Another important service: Giving providers tools, like spreadsheets, to keep track of their audits.

Consultants like The van Halem Group and The Audit Team don't expect the demand for their services to let up anytime soon. In many cases, providers don't have the manpower to handle the sheer number of requests they're receiving, making outsourcing part or all of the process a matter of survival.

“Although there will be fewer audits as providers revamp their intake and take more of a hard line on documentation, it's always going to be there,” said Rick Worstell, CEO of Harrington Management Group and The Audit Team. “It's the new normal.”

Even if manpower's not an issue for a provider, expertise often is, Worstell says.

“Do you know if your staff can win these audits,” he said.

For their part, billing companies are stepping in to help struggling providers respond to audits in an accurate and timely fashion.

“We've had clients ask us, 'Can you do anything to help?'” said Ed Bauer, national sales manager for Noble House, which recently released a tool that allows providers to respond to audits electronically. “In an audit, they hold reimbursement for a period of time, which really affects cash flow, so it needs to be as painless as possible.”

While consultants and billing companies may stand to make an extra buck or two due to audits, it's a we're-in-this-together mentality that's the real driver behind their services, they say.

“If they have to go through it, we have to go through it, too,” said Tim Barone, a partner in charge of business development at Acu-Serve, which recently launched a new service to help providers respond to audits.