SMRC warns of audit risk—for ordering practitioners

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Tuesday, January 7, 2020

ATLANTA – The SMRC is holding ordering practitioners accountable and acknowledging that provider payments for DMEPOS are reliant on their documentation, the van Halem Group reports.

The requirement for practitioners to comply with a provider’s request for documentation has been part of the Program Integrity Manual for some time, but in its most recent project detail for diabetic test strips, the SMRC says:

“If a practitioner doesn’t respond to a supplier’s request for documentation to support the DTS billed, CMS is concerned that the practitioner may also have other services that are not supported by documentation. Therefore, we are now auditing those practitioners’ claims for evaluation and management services.”

This is a win for providers, the van Halem Group says.

“Suppliers have long communicated to CMS and its contractors the imbalance in documentation requirements and audits when reliant on the ordering practitioner,” it stated in a blog. “The A/B and DME MACs often work together to educate providers on the importance of documenting for DMEPOS orders. Unfortunately, the MACs have not shown any further collaboration besides education...until now.”

The van Halem Group recommends that providers share this notification with “difficult” referral sources.