Meet SMRC, Medicare's newest audit contractor

WASHINGTON - StrategicHealthSolutions, a new audit contractor, has begun targeting claims for post-pay review. The problem, say stakeholders: Many have already been audited.

“There's only a select pool of providers, and a select pool of claims to pull from,” said Andrea Stark, a reimbursement consultant with MiraVista.

Medicare contracted with the Omaha, Neb.-based StrategicHealthSolutions to serve as a Medicare supplemental medical review contractor (SMRC) in 2012 to “identify and employ more efficient methods of medical review, such as data extrapolation” and lower improper payments for fee-for-service claims, according to its website.

So far, it looks like the contractor is going after sure bets, say stakeholders, like power mobility claims, which typically have high error rates.

“They're looking for situations where there's a high likelihood there's going to be an issue,” said Stephanie Morgan Greene, general counsel for Harrington Management Group, also known as The Audit Team.

Provider Dave Hosemann had just provided requested information on a claim to another auditor when StrategicHealthSolutions requested the same information on the same patient. StrategicHealthSolutions told Hosemann it hadn't meant to duplicate another auditor's efforts, but asked him to provide the information, anyway.

“Does the left hand know what the right hand is doing here?” said Hosemann, owner of Vicksburg, Miss.-based Hometown Medical. “I think someone has to make a decision on whether these entities want beneficiaries taken care of or whether they don't.”

Provider Mark Farmer has also experienced double dipping: Three of the four claims StrategicHealthSolution is currently reviewing have already been audited. That puts even more stress on his staff.

“It's so labor-intensive to respond to these audits,” said Farmer, president of Mesa, Ariz.-based Southwest Mobility. “They're relentless.”

The only hope for reducing audit scrutiny is to ensure you have a high approval rate, says Greene.

“Take every audit extremely seriously,” said Greene. “If you pass a random DME MAC audit, the likelihood of another audit is significantly lowered.” HME