AAHomecare Talks Audits and Error Rates with Jurisdiction A

ARLINGTON, Va. — Last week, AAHomecare staff met with
officials from DME MAC Jurisdiction A (NHIC) to talk about reducing
error rates in the Comprehensive Error Rate Testing (CERT) program.
According to the association, under the old CERT methodology,
auditors used clinical inference to determine whether a claim was
improper. But CMS has instructed contractors to stop using clinical
inference and rely strictly on whether the available documentation
meets the requirements outlined in Medicare policies and coverage
criteria.

“We are very concerned that there are cases where CMS audit
contractors are exceeding their authority and seeking documentation
that is not called for in the coverage policy or outlined in the
Medicare Program Integrity Manual,” AAHomecare reported in its July
14 newsletter. “We believe that CMS must revise a number of its
unreasonable audit practices — such as progress notes for a
COPD patient on oxygen or documentation of continued use of the HME
item.” The association said it would like to see “clear and defined
rules that HME providers are able to follow in order to submit
clean claims.”