Medicare Audits Have Run Amok, Task Force Finds

ARLINGTON, Va. — An AAHomecare task force has published a white paper that concludes some Medicare audits are not only unfair but also contrary to coverage criteria and don't comply with applicable laws and regulations.

After looking at dozens of sample letters received by HME providers nationwide, the report shows government contractors "often deny claims for reasons that are not specified in a controlling national or local coverage determination or impose new documentation requirement without notice to providers."

AAHomecare is recommending that CMS should:

• Not permit contractors to apply new audit strategies retroactively.
• Establish clear, consistent rules on the medical necessity criteria and documentation that contractors may request in an audit.
• Publish the criteria for comment and include HME providers and physicians in this process. Once there are clear guidelines, contractors may enforce them prospectively.
• Establish parameters on the manner in which ZPICs perform audits.

Read the white paper on the AAHomecare website.