Navigation Links
Medicare's Audit Process Hampers Access to At-Home Care
Date:7/5/2011

ARLINGTON, Va., July 5, 2011 /PRNewswire-USNewswire/ -- Over-reaching by federal audit contractors in Medicare is restricting the ability of legitimate providers to supply medically required care and equipment to patients.  The American Association for Homecare is working with policy makers to ensure that fraud prevention efforts are effective at stopping fraud without limiting access to care.

At a June fraud prevention summit conducted by the U.S. Department of Health and Human Services and the Justice Department, the administrator of the federal Centers for Medicare and Medicaid Services (CMS) admitted that audits designed to detect fraud are a "blunt instrument." After hearing several complaints from healthcare providers participating in the fraud prevention summit, another CMS official stated that federal officials will conduct an "audit audit" to ensure that audit contractors do not needlessly hamper legitimate providers.

"The current auditing strategy is expensive, inefficient, and distorts the Medicare claims error rate for at-home care products," said Tyler Wilson, president of the American Association for Homecare. "The burdensome process disrupts the service and care provided to patients in need of these at-home services and severely taxes providers' resources."

In 2008, the Medicare homecare claims error rate was approximately nine percent. However, in 2009 CMS adopted its new auditing criteria, which resulted in a claims error rate of 52 percent. In 2010, the claims error rate jumped to an astonishing 75 percent, incorrectly suggesting that three out of four Medicare claims for at-home equipment and services are paid improperly or are the result of fraud or abuse.

"When 75 percent of Medicare HME claims are considered to be improper, we believe that this shows a breakdown in the system.  The American Association for Homecare is working to inject common sense and accountability into the audit process and address the complexity of Medicare at-home coverage policies to ensure that beneficiaries are receiving medically necessary items and services.  Both these steps are necessary to make the program work better for all stakeholders," said Wilson.  

Current audit standards employed by Medicare contractors are having the following unintended consequences:

  • Data regarding fraud is being distorted;
  • Eligible Medicare beneficiaries are not receiving medically necessary and covered benefits;
  • Auditors for CMS misinterpret and then misapply Medicare rules and regulations, sometimes on a retroactive basis, leading to inaccurate error-rate data;
  • Legitimate providers furnishing medically necessary items and services are being hurt by unjustified monetary recoupments; and
  • CMS will not be able to achieve the Administration's goal of reducing the error rate until it modifies its current audit policies.

The American Association for Homecare represents durable medical equipment providers, manufacturers, and other organizations in the homecare community. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. The Association's members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org/athome.


'/>"/>
SOURCE American Association for Homecare
Copyright©2010 PR Newswire.
All rights reserved

Related medicine technology :

1. American Scientific Resources Inc. Discloses Audited Financials for 2007 and 2008
2. LifeVantage Announces Preliminary Unaudited First Quarter Revenue
3. ISTA Pharmaceuticals Announces Preliminary, Unaudited Revenue of $110.6 Million in 2009
4. LifeVantage Announces Unaudited First Quarter Fiscal 2010 Financial and Operating Results
5. ReSearch Pharmaceutical Services, Inc. Unaudited Quarterly Report for the Period Ended September 30, 2009
6. Simcere Pharmaceutical Group to Announce Fourth Quarter and Fiscal Year 2009 Unaudited Financial Results on Tuesday, March 16, 2010
7. Simcere Pharmaceutical Group Reports Preliminary Unaudited First Quarter 2010 Results
8. Abviva Engages W.T. Uniack & Co. As Independent Auditor
9. eDataAudit Receives Approval from the American Board of Radiology
10. China BCT Announces Auditor Change Within PKF Network
11. OmniComm Systems Announces Auditor Change
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:3/29/2017)... March 29, 2017  Experts in the field ... devices like  Soberlink Systems  as a model for ... published in early 2017, concluded that remote blood ... managing patient recovery." The findings of ... Addiction Medicine, detail a range of variables that ...
(Date:3/29/2017)... , March 29, 2017  Glenmark Pharmaceuticals, ... for GSP 301, an investigational fixed-dose combination of ... mcg) administered twice-daily as a nasal spray being ... These results are from a recently completed Phase ... GSP 301 combination therapy versus mometasone, olopatadine or ...
(Date:3/29/2017)... 29, 2017 Research and Markets has announced ... report to their offering. ... The global lifestyle drugs market to grow at a ... report, Global Lifestyle Drugs Market 2017-2021, has been prepared based on ... covers the market landscape and its growth prospects over the coming ...
Breaking Medicine Technology:
(Date:3/29/2017)... ... 2017 , ... Based on research from Guardian’s Fourth Annual ... trying to balance both short-term and long-term benefits demands. Are employers struggling ... complexity, companies are finding that the short-term strategies used to control costs, improve ...
(Date:3/29/2017)... Chicago, Illinois (PRWEB) , ... March 29, 2017 ... ... Visio Stencils Device Library for documenting and diagramming network and data center assets ... , NetZoom subscribers can request new equipment shapes for free and download ...
(Date:3/29/2017)... ... , ... Immunotherapy has emerged as one of the most promising options for ... the next revolution in our fight against this complex disease. One of the most ... inhibitors such as PD-1 and PD-L1 inhibitors. , While a few single analyte immunohistochemistry ...
(Date:3/29/2017)... ... ... AvePoint , the Microsoft Cloud expert, is pleased to announce the ... the Riverfront Plaza, 901 East Byrd Street. AvePoint is celebrating with a ribbon-cutting ceremony ... Mayor of Richmond Levar M. Stoney. , Founded in 2001, AvePoint employs more than ...
(Date:3/28/2017)... ... March 28, 2017 , ... India’s Chigurupati Technologies ... directly address the resolution to globally reduce the harmful use of alcohol set ... FDA and TTB approved ingredients that when infused into alcohol, renders the alcohol ...
Breaking Medicine News(10 mins):