RAC Review of DME Claims Crossing Hospital Stays Limited to After April 1

WASHINGTON (April 22, 2015)—From AAHomecare: In one of the biggest regulatory wins of the last decade, CMS has announced that RAC reviews of DME items provided while a beneficiary was in a Part A stay -- including hospitals and nursing homes -- are limited to DME claims paid on or after April 1. While DME and related supplies are covered for the entire 30 days of such stays, the automatic RAC audits were going back several years to review these types of claims. But those DME suppliers weren’t able to re-file those claims due to the timely filing requirement. After working collaboratively with AAHomecare, CMS issued a technical direction letter to RAC contractors to advise them to audit DMEPOS to Part A claim payments and recoup only when the claim was paid on or after 4/1/15. “By presenting the facts instead of being guarded, we’re building credibility and trust, and this type of collaborative discussion is the result of that,” said Kim Brummett, vice president of regulatory affairs at AAHomecare. “CMS heard us, and within a matter of weeks, we had a common sense fix that will provide significant relief to suppliers. These changes will allow suppliers to manage and work within the system when DME claims cross over a Part A stay.” “The old approach of seeing CMS as the enemy isn’t going to get anyone anywhere,” said Tom Ryan, president and CEO of AAHomecare. “In any long-term relationship, it is important to develop and maintain mutual respect. Kim Brummett recognized that from day one at AAHomecare and she has been fostering a good faith relationship with CMS step by step.” The new process, called an informational unsolicited response (IUR) will be implemented for dates of service 4/1/15 and forward which will automatically compare DMEPOS claims paid to Part A claims. If a DMEPOS claim has been paid where the from date of service is during the Part A stay, the payment will be automatically recouped. Suppliers will need to monitor their electronic remittance notices (ERNs), and when a recoupment has been made, the suppliers should research to determine when the patient was in the Part A stay and submit amended claims post discharge if the patient had continued to use the equipment/supplies.