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."