CMS: Audits Won’t Fully Resume on Aug. 3

After AAHomecare shared industry concerns over audit resumption, CMS provided a more nuanced and detailed description of how the audit programs will recommence.

• By David Kopf
• Jul 23, 2020

After announcing last week that it would resume prior authorization for power mobility devices and support surfaces on Aug. 3, CMS is now providing more details on how it would approach the resumption of audits.

After CMS’s announcement, the American Association for Homecare met with the agency to share the industry’s concerns that, with COVID-19 cases rising dramatically, it wasn’t the right time to restart auditing HME providers when they are helping patients with COVID-19 and alleviating pressure on hospitals and clinicians.

“CMS understood these concerns and to ease the burden on suppliers, CMS clarified that audit activity will not fully resume on Aug. 3,” AAHomecare reported.

Specifically, CMS will do the following:

• Audits will begin with DME MAC post-pay reviews, which will allow for more flexibility than pre-pay reviews and will not hold up payments to suppliers. 
• Targeted Probe and Education (TPE) audits are not included in this rollout of audits and there is no timeline for TPEs to resume.
• DME MACs may allow extensions and the canceling of an audit based on suppliers' ability to complete the audit.
• Currently, there is also no timeline set to restart Supplemental Medical Review Contractor (SMRC) reviews and Recovery Audit Contractor (RAC) audits.

CMS’s suspension of DME MAC, TPE, SMRC, and RAC audits has been in place since March 30.

Other audit details CMS shared with AAHomecare:

• It would start audits on a delayed timeframe, and suppliers should not expect audit requests on Aug. 3.
• DME MACs will audit claims started during the public health emergency, and will be pulling claims from some time prior to March 1.
• CMS is tracking and sharing state and county-level COVID-19 case data with the MACs so they can take that information into consideration. 

“We thank CMS for taking the time to discuss DMEPOS industry concerns and providing insight into their approach with this change,” a statement from AAHomecare read. “While we do not support going back to normal audit activity during the pandemic, we appreciate CMS’s approach to resume program integrity activities in phases.”