Refunds for RAC Audit Snafu in Jurisdiction D

FARGO, N.D. — The Recovery Audit Contractor in DME MAC
Jurisdiction D will no longer target CPAP equipment and supplies
for audits when Medicare did not pay for the required sleep test,
AAHomecare reported last week.

HDI, the RAC in the 17-state region, had been recouping money for CPAPs
and supplies if the beneficiary did not have a sleep test paid
for by Medicare. But CPAP therapy is frequently prescribed before
patients are Medicare-eligible.

“They did not know how to interpret the policy,” said The MED
Group’s Kelly Riley, who chairs the sleep task force for the
association’s HME/RT Council and is a member of the Region D DME
MAC Advisory Committee.

CMS staff acknowledged that the practice was a misinterpretation
of Medicare policy and said the automated audit reviews would be
stopped, AAHomecare said.

“CMS said that if they do suspect problems, they will use
discretion to conduct complex reviews,” according to the
association’s March 2 newsletter. “Staff also indicated that they
would be refunding money that has been collected due to the
misapplication of the policy.”

For providers who have already filed appeals resulting from such
audits, Riley said, “Wait, the money will not be recouped.”
Generally, she said, “without an appeal, the funds are recouped per
the policy at around day 41 post notification. The appeal stops the
clock until a determination is made.”

While neither CMS nor NAS, the Jurisdiction D DME MAC, has
issued a notice about how the issue will be handled, more
information could be forthcoming on a DAC call scheduled for March
8, Riley said.

She said the sleep task force had verified that the same types
of audits were not occurring in any other region.

If other issues with the RACs arise, Riley said, providers
should “reach out to other stakeholders” and work collaboratively
toward a solution. That, she said, “is exactly what happened this
time.”