AAHomecare continues working with CMS on audit relief

WASHINGTON, D.C., Dec. 13, 2012—AAHomecare recently asked the Centers for Medicare & Medicaid Services (CMS) for relief from Recovery Audit Contractors for recoupments on submitted claims when the anniversary billing date overlaps with a Medicare Part A stay (i.e., skilled nursing facility or hospital stay). Currently, Medicare policy dictates that regardless of how long a beneficiary uses prescribed home medical equipment in his or her home, if the patient was not at home on the billing date, the Medicare payment for the rental month was made in error. This policy has confounded and frustrated HME providers for some time. And the situation has only gotten worse as audit contractors increase auditing activity.

“This policy simply makes no sense. A beneficiary could be using oxygen or hospital bed for 26 days of a month but just because an inpatient stay occurs on the anniversary billing date, the HME provider is held accountable,” AAHomecare’s Walt Gorski said. “Policymakers need to know that when a patient has to go into a skilled nursing facility or hospital, the beneficiary’s first thought is not to call the HME provider so that the provider does not submit a claim. We should not be an ATM for these audit contractors.”

AAHomecare has met with CMS officials to seek relief. The Association made two recommendations:

1) CMS should instruct audit contractors not to recoup monthly HME rental payments based exclusively on the anniversary date corresponding with an in-patient stay. Recoupments should only be justified when the Part A stay would preclude use of the equipment for the full anniversary date billing cycle. If the patient uses the equipment in the home setting at any time within the anniversary date billing cycle, payment should stand. The rationale behind this recommendation is that the patient may still be using HME in the inpatient setting and upon discharge will again be using the equipment in the home. The benefits to CMS and its contractors are that this proposal could be easily implemented and would reduce unnecessary audits, claim adjustments, claim reprocessing, and subsequent appeals. This saves time and money for the DME MACs, QICs, providers, and the audit contractors.

2) To address HME claims that have already been recouped for overlapping dates of service due to a Part A covered stay, CMS should allow the HME provider to pursue the reopening process (or submit a revised claim) to reflect the time period the beneficiary was using the equipment in the home setting. This is similar to what occurs today when a claim is denied in an audit but the denial is reversed on appeal and paid even though it is past the timely filing deadline.

For more information on this issue please contact Gorski at (202) 372-0750. Also visit www.aahomecare.org.