CMS to modify oxygen audit process, according to AAHomecare

The American Association for Homecare reported late last week that the Centers for Medicare & Medicaid Services (CMS) had agreed that durable medical equipment Medicare administrative contractors (DME MACs) will change how oxygen claims are reviewed in audits.

AAHomecare said CMS addressed several concerns with the oxygen auditing process after meetings with the association and other stakeholder organizations.

“AAHomecare voiced concerns to CMS and the DME MAC medical directors on numerous occasions requesting that the DME MACs focus on auditing more recent claims, with an initial date of service within the last few months, rather than claims that would require documentation from several years ago,” AAHomecare reported. “In response, CMS will be working with the DME MACs to develop a process to compare the error rate for ‘new’ oxygen claims with the entire universe of oxygen claims that are under review.”

AAHomecare had also recommended that if DME MACs continue to focus on old claims, they should increase the 30-day response timeframe to allow sufficient time for medical providers to gather necessary documentation. AAHomecare reported that CMS has agreed to revise the Program Integrity Manual to increase the amount of time suppliers have to respond to an audit from 30 days to 45 days.

In another issue getting attention from AAHomecare, CMS posted new changes to the power mobility device (PMD) prepayment review/prior authorization demonstration. CMS made the following modifications:
• Medicare contractors will review in 20 days. The 20 days are counted from the date the last piece of documentation is received.
• Medicare contractors begin 100 percent prepay review when the 20-day review period timeframe can be met. Contractors will not request more claim records than they can review within 20 days.
• Medicare contractors will issue a detailed denial letter noting why the claim is denied.
• Medicare contractors will allow suppliers to submit documentation with a claim, however if documentation is missing more documentation can be requested.

AAHomecare, which has been working with CMS on the issue, reported that some of changes are improvements, but the program should still be halted.