Medicare PrePay Audit for Oxygen and CPAPs for all MACs


As I understand it, all Oxygen and CPAPs in all Medicare MAC regions are on prepayment status.  This means you will be getting additional documentation or development request letters to provide documentation to support medical need prior to the claims being paid.  This evidently is being discussed in Mac Council Meetings this month.

How to do improve turnaround time?

You need to obtain all documentation, physician chart notes, date last seen initial and renewal (if applicable), and copies of test results at the time of the order intake and certainly PRIOR TO BILLING.  Waiting until the request is received puts your business in danger of missing the deadline due to the physician failing to see the importance of a timely response to the request for records.

What is your plan?

Have you diversified your business model with higher ratio of commercial payers?  If not and you want to increase to likelihood of sustaining prepayment audit while Medicare penalizes everyone in the industry with this prepayment plan you need to look at diversification.

If you have better ideas for fighting fraud and abuse beside penalizing everyone in the industry with prepayment audits, the Senate Finance Committee is seeking input from the healthcare community.  Speak up!

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria through compliance program development, management and training.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back-end collections. You can visit our website at Medical Auditing Solutions LLC.

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