Lean less heavily on waivers

ATLANTA - As the HME industry ventures further into a post-pandemic landscape, providers should move away from reliance on audit waivers and flexibilities, Medtrade East speakers say. 

While audits never stopped completely during the throes of COVID-19, federally sanctioned waivers helped staunch the burden to providers while the pandemic raged. Yet, now with the viral threat easing up, so are the audit breaks. 

“I strongly encourage any suppliers who are relying on waivers and flexibilities to discontinue their use, if possible,” said speaker Denise Leard, shareholder with Amarillo, Texas-based Brown & Fortunato. “COVID has not gone away but it is not as disruptive and many of the waivers which may still be in place are not needed.” 

Leard is one of several industry experts leadings sessions on audits during Medtrade East, which takes place Oct. 24-26 at the Georgia World Congress Center in Atlanta. 

Audits are “definitely picking back up,” Leard says, suggesting every provider implement a valid corporate compliance plan that includes routine self-audits.  

“Identifying any potential problems and taking corrective action prior to a CMS audit is going to lessen any damage and save the supplier from headaches,” she said. 

Speaker Kelly Grahovac, general manager of Atlanta-based The van Halem Group, advises providers “to operate as if waivers and flexibilities are no longer in place and work to obtain the normal required documentation whenever possible.” 

In the event a provider must rely on waivers, Grahovac advised “be sure to flag these claims for easy identification later on.” Along with flagging claims, she said it is “imperative to take good notes on why the particular waiver was utilized in the event of an audit.” 

It is also important that provider compliance programs include an audit strategy to help analyze and mitigate risk, speakers say. 

“Just as important as an audit strategy is incorporating corrective actions, training and updated policies and procedures whenever an audit identifies risk areas,” Grahovac said. “Be sure to have someone regularly checking contractor sites to stay on top of changes that pertain to the PHE.” 

Speaker Wayne van Halem, founder of The van Halem Group, also points out that “we do not know what the post-pandemic looks like yet.” CMS has not indicated whether equipment furnished during the pandemic will be “grandfathered” or if providers will need to go through a requalification process, he said. 

“I imagine it will be a combination, depending on the type of equipment and whether or not it is capped out,” van Halem said. “We have seen a number of audits now of claims for respiratory equipment submitted during the pandemic with the CR modifier and the auditors focused on documentation of continued need with 12 months prior to the date of service in review. So, it is very important to make sure they are obtaining that on an annual basis, even on the CR modifier claims.”