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audits

Stakeholders slam self-audits

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10/12/2018

WASHINGTON – A recent request by the DME MAC contractors for certain CPAP providers to audit themselves is setting them up to fail, say industry stakeholders.

van Halem: ‘Aggressive’ UPICs take over

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09/24/2018

ATLANTA – It’s time for HME providers to reacquaint themselves with the Unified Program Integrity Contractors, or UPICs, says Wayne van Halem.

Enteral nutrition, surgical dressings top error list

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05/15/2018

WASHINGTON – Enteral nutrition had the highest error rate (87%) from Targeted Probe and Educate audits in Jurisdiction D.

Judge getting impatient with HHS over massive ALJ backlog

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Friday, April 6, 2018
Elizabeth Hogue

I recently wrote an article entitled "Court Says No Recoupment Until After ALJ Hearings."  This article was about a court decision in which the judge said that recoupment of an extrapolated overpayment as a result of a ZPIC audit could not begin until after ALJ hearings were held.

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‘It is no longer worth the pit in my stomach’

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Wednesday, April 4, 2018

It’s always disappointing when the HME industry’s efforts to get relief from Medicare’s competitive bidding program fail to cross the finish line. But this last time around, when H.R. 4229 failed to make the cut in a recently passed omnibus bill, it was particularly disappointing.

Noridian named new SMRC contractor

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03/23/2018

FARGO, N.D. – Noridian Healthcare Solutions has been awarded a $227 million Supplemental Medical Review Contractor (SMRC) contract by CMS. The primary role of the SMRC is to conduct nationwide medical review of Part A, Part B and DME providers as directed by CMS.

New audit software helps to identify potential problems

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12/29/2017

FORT LAUDERDALE, Fla. – It’s no secret that audits, and all the administrative complexities that accompany them, have been the bane of the HME industry for years. But a recently formed partnership between HME stakeholders aims to change that.

Statistics, silver linings, no sense

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Friday, October 20, 2017

I’ve had a few conversations now where the people I’m talking to try to find the silver lining in the statistic that the number of DME locations has dropped about 40% since 2013, when Medicare’s competitive bidding program began to really gain steam.

HME: Not so hip on HIPAA?

‘The No. 1 focus of audits is the security and risk assessment, which is woefully missing in this industry’
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10/13/2017

ATLANTA – Industry consultants report a number of HIPAA-related audits making the rounds in the HME industry and the best they can tell, providers, for the most part, are not prepared for them.

CMS sets start date for targeted audits

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09/22/2017

WASHINGTON – CMS will expand its Targeted Probe and Educate program to include all of the Medicare Administrative Contractors effective Oct. 1.

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