Congresswoman Renee Ellmers Introduces Audit Reform Bill, HR 5083

ObkfP.AuSt.91(Cary, NC) – Congresswoman Renee Ellmers (R-NC) continues her diligent efforts to ensure home medical equipment providers can care for the patients that need them rather than waste time and money on burdensome audits that are unnecessary. Her most recent action is to introduce a bill in Washington today, called “Medicare DMEPOS Audit Improvement and Reform (AIR) Act of 2014”.

“It is a pleasure to continue to work with Congresswoman Ellmers and her staff to do all we can to protect our industry and the patients they serve,” commented Beth Bowen, executive director of NCAMES. “Many groups, including AAHomecare and VGM, collaborated in this effort to build relationships and to put together a bill that would pass and make a difference with original co-sponsors that will work hard to garner support.”

NCAMES is fortunate to have Family Medical and Joey & Billy Tart of Dunn as active members with close ties to Congresswoman Ellmers and her staff. Joey Tart shared, “We are pleased with the relationship we have developed with the Congresswoman and her staff who have all worked tirelessly to bring our issues to the forefront. We are thankful to have her on our side as she understands our industry and the many burdens we face. It’s exciting because she knows our industry is part of the solution.”

With strong bi-partisan support from Democrats Cong. Braley (IA-1) and Cong. Barrow (GA-12) plus Republicans Cong. Duncan (TN-2) and Cong. Thompson (PA-5), this bill is surely to gain support swiftly.

Congresswoman Renee Ellmers (R-NC-02) released the following statement this afternoon after introducing H.R. 5083 – The Medicare DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) Audit Improvement and Reform (AIR) Act of 2014:

“Thousands of small businesses across the country are facing complex and unnecessary burdens just so they can get compensated for the medical equipment they are providing for our seniors. This is happening because of an excessive auditing system enforced by the Department of Health and Human Services (HHS).”

“The current auditing process has important merits and was put in place because of the fraud and abuse that exists within the Medicare system. But instead of targeting illegal practices and bad actors, HHS is instead choosing to focus on people who are playing by the rules and providing jobs for millions of hardworking Americans. At the same time, third-party contractors are profiting over these excessive audits and being used by HHS to halt payments to providers for as many as three years.”

“I have seen this first hand in my district. One of our local businesses provides essential medical equipment, including oxygen and hospital beds. Over the past year they have been audited nearly 50 percent of the time. This is a practice that has to end, and that’s why I have introduced legislation that will address this issue, reform the system, and focus on targeting the fraudulent practitioners that need to be held accountable.”

This morning, Congresswoman Ellmers introduced H.R. 5083 – The Medicare DMEPOS Audit Improvement and Reform (AIR) Act of 2014 – with strong bipartisan support. Specifically, under the AIR Act:

  • DMEPOS suppliers will receive a score on their error rates. Suppliers with low errors rates will receive fewer audits.
  • DMEPOS suppliers with error rates of 15 percent or lower will only be subject to one random audit for the year they have a low error rate.
  • Clinical inference is restored in the audit process.
  • Look-back periods are limited to three years rather than five years for MACs and four years for RACs.
  • MACs and RACs must provide quarterly training on avoiding frequent payment errors, including notice of all new audit procedures and education to avoid clerical errors.

MACs and RACs were created through the Medicare Modernization Act of 2003 to identify and recover improper payments to healthcare providers under Medicare plans. While MACs and RACs have successfully recovered millions in improper payments, they have also strained providers with increased administrative burdens. This bill will reform the Medicare audit process for DMEPOS claims and make it more efficient. The AIR Act will also increase transparency, education and outreach, and reward suppliers that have low error rates on audited claims.

ABOUT NCAMES

With about 200 member companies, the North Carolina Association for Medical Equipment Services (NCAMES) is the statewide leader in preserving access to safe, affordable, and therapeutic home medical equipment. We provide advocacy & education to HME providers statewide dedicated to helping North Carolina’s growing senior population and patients of all ages gain more mobility and experience a high quality of life in the comfort and privacy of their own homes. Instrumental in passing the nation’s first HME licensure law which has been working to ensure quality home health care since 1995, NCAMES continues to advocate for seniors and patients in need. For more information, visit www.ncames.org or call (919) 387-1221.

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