Audits slowly ramp up

WASHINGTON – The DME MACs are moving forward with audits for claims filed after March 2020, when COVID-19 hit the U.S. and certain waivers went into effect, but audit experts don’t anticipate any widespread problems. 

Early in the pandemic, CMS temporarily waived several requirements, including coverage criteria, face-to-face requirements and delivery signatures for respiratory equipment.  

“The MACs have been easing into audits since last August, even though they withheld those pandemic claims,” said Kelly Grahovac, a senior consultant with The van Halem Group. “If everything goes as directed, a supplier who took advantage of waivers and flexibilities, and documented it – I'm not concerned.” 

The waivers are in effect through the public health emergency, which, at present, extends through July but could extend through the end of the year. 

As to the possible product categories under scrutiny, Grahovac thinks the MACs will stick with those currently under post-payment review like orthotics, urological and surgical supplies, and CGM devices and supplies. 

“I do think that eventually respiratory products will get their turn, but for now they will ease into it and keep doing what they’re doing,” she said. 

Grahovac is less concerned about what claims the MACs are auditing than how they’re handling the audits.  

“Will there be consistency across the board between the contractors?” she said. “Will they be looking at documentation the same, considering these were a part of the pandemic timeframe? Those things give me pause, until we see what these audits look like.” 

In addition to the MACs, other Medicare contractors like the RACs and the SMRC are also conducting audits. State Medicaid programs and commercial payers are also in play. 

“The supplier community is getting hammered with audits from several contactors,” said Ronda Buhrmester, senior director of payer relations and reimbursement for VGM & Associates. “They have staffing, increased costs and so many other issues they are facing that I feel like CMS doesn’t understand fully. CMS and other payers need to recognize what the DME industry has continued to face.”