The audit crisis became even more severe recently when the Office of Medicare Hearings & Appeals (OMHA) decided to suspend assigning appeals to administrative law judges that come from RAC audits. The suspension will last two years in order to clear up a massive 357,000 claim backlog. AAHomecare sent a letter of protest to Department of Health & Human Services Secretary Kathleen Sebelius.

In the letter, the Association noted that an unintended consequence of OMHA’s decision may be to shift more of the administrative burden and risk inherent in Medicare coverage and payment rules to beneficiaries as providers will be more reluctant to take on added risk of nonpayment.

To alleviate some of the most egregious problems associated with audits, AAHomecare recommended:

a moratorium on MAC pre- and post-payment audits until the appeals backlog is reduced to not more than six months.
a limit on widespread product-specific pre- and post-payment audits.
excluding providers from pre- or post-payment audits for one year if they demonstrate a low payment error rate.
prohibiting contractors from repeatedly auditing the same beneficiary’s claims for a product or service if it was determined to be medically necessary during a previous audit.
impose product- and provider-specific limits on the volume of claims.

Increased volumes of pre-payment reviews have caused this crisis, and CMS is directly responsible for both its own audit actions and those of its contractors that have brought the situation to this breaking point. Addressing audits has been priority for AAHomecare for quite some time, and will have an even more prominent role in the Association’s activities in 2014.

AAHomecare has set up a dedicated email address (AuditProblems@aahomecare.org) to allow providers to quickly and easily share their audit stories with us. We will use these stories to help regulators and legislators understand the crushing impacts that audits are having, so please tell us what’s happening with your business!

If you have any questions, contact Kim Brummett, AAHomecare senior director of regulatory affairs.

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