Speaker Q&A: Get paid the first time

PHOENIX - While respiratory products may be spared in the short term, audit activity is increasing overall, says Wayne van Halem, president of The van Halem Group. Here’s what session co-hosts van Halem and Sarah Hanna, CEO of ECS North, have to say about what to expect in 2022 and how to get paid the first time. 

HME News: What is the state of audits right now?  

Wayne van Halem: The biggest thing I see on the horizon is that the ALJ backlog will be resolved probably mid-2022, at which point the Office of Medicare Hearings and Appeals (OMHA) will be staffed to conduct 300,000 appeals annually within a 90-day timeframe. Once they are caught up, I am concerned we will see a significant increase in audit activity during the second half of this year and I think the RACs will be the most likely tool that CMS utilizes. 

HME: What’s one good way for providers to improve their processes and collections? 

Sarah Hanna: Training, understanding the payer’s coverage criteria and diligence are the best areas to focus on for improving collections. When the team knows areas like prior authorization requirements, modifiers, date spans and documentation requirements, it improves the claim being paid the first time.     

HME: Staffing shortages and increased costs can wreak havoc on resources. What can providers do to minimize them? 

Hanna: There is no magic wand for dealing with the staff shortage. I would say that creating a work environment where your team has an emotional attachment to their colleagues, the company, the customers and the mission is your best opportunity for success. Retention is the best defense to the increased cost companies experience from turnover. To combat the increased costs on businesses due to supply chain issues, that would be continual cashflow to prevent a cash crunch from denied claims.