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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Senate Finance Committee Seeks Feedback on Fighting Fraud & Abuse as They Look at ZPICs

Reposted from email blast received May 2, 2012.
FOR IMMEDIATE RELEASE
May 2, 2012
CONTACT:  Julia Lawless/Antonia Ferrier (Hatch)              (202) 224-4515
                            Communications Office (Baucus)                          (202) 224-4515 

HATCH, BAUCUS LEAD FINANCE COMMITTEE MEMBERS IN BIPARTISAN EFFORT TO COMBAT WASTE, FRAUD, & ABUSE IN
MEDICARE & MEDICAID PROGRAMS
In an open letter to members of the health care community Senators write, “Drawing on the collective wisdom and accumulated insights of thousands of professionals and individual experiences could offer a fresh perspective and potentially identify solutions that may have been overlooked or underutilized.”

WASHINGTON – Today, six members of the Senate Finance Committee, led by Ranking Member Orrin Hatch (R-Utah) and Chairman Max Baucus (D-Mont.), announced a bipartisan effort to begin soliciting ideas from interested stakeholders in the health care community regarding effective solutions to improve federal efforts to combat waste, fraud, and abuse in the Medicare and Medicaid programs. Joining Hatch and Baucus in the effort are:  Senators Tom Coburn (R-Okla.), Ron Wyden (D-Ore.), Chuck Grassley (R-Iowa), and Tom Carper (D-Del.).

In an open letter to members of the health care community, the Senators wrote, “We believe federal efforts would be strengthened by input from members across the health care community – providers, payers, health plans, contractors, non-profit entities, consumers, data analytics entities, governmental partners, and patients. Drawing on the collective wisdom and accumulated insights of thousands of professionals and individual experiences could offer a fresh perspective and potentially identify solutions that may have been overlooked or underutilized.”

This week, the lawmakers invited interested stakeholders to submit white papers offering recommendations and innovative solutions to improve program integrity efforts, strengthen payment reforms, and enhance fraud and abuse enforcement efforts. Submissions are due by June 29, 2012. A summary document highlighting key proposals will be compiled and released later this year.

The Senate Finance Committee has jurisdiction over the Medicare and Medicaid programs.

To view a signed copy of the letter click HERE.

Below is the full text of the letter:

May 2, 2012

To Members of the Health Care Community:

According to the Government Accountability Office (GAO), few programs are as much at risk for fraud, waste and abuse as the Medicare and Medicaid programs.  Estimates of the amount of fraud and misspending in these programs vary widely, from $20 billion to as much as $100 billion. Just this week, testimony before the Senate Finance Committee underscored the seriousness of this problem, as witnesses testified that while much has been accomplished in the fight against fraud and abuse, much more needs to be done.  As Senators and members of the Finance Committee, we have a duty to ensure that taxpayer funds are being spent wisely.

Combating fraud in Medicare and Medicaid has long been a challenge for the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services Inspector General (HHS OIG) and the Department of Justice (DOJ).  To date, numerous efforts have been made to reduce fraud, yielding a mixed record of successes and failures.  We believe federal efforts would be strengthened by input from members across the health care community – providers, payers, health plans, contractors, non-profit entities, consumers, data analytics entities, governmental partners, and patients. Drawing on the collective wisdom and accumulated insights of thousands of professionals and individual experiences could offer a fresh perspective and potentially identify solutions that may have been overlooked or underutilized.

Today we are announcing an effort to solicit ideas from all interested stakeholders in the health care community, regarding solutions and suggestions for how to better prevent and combat the multi-billion dollar problem of waste, fraud and abuse in the Medicare and Medicaid programs.  We invite you to submit white papers offering your best ideas, built on years of experience and insight.  We want to know what areas you see for improvement in current program integrity efforts, as well as additional solutions that we should consider. Working together, we hope to identify innovative solutions that will provide taxpayers with a better return on the investments being made to combat the overpayments in these federal health care programs.

Below are the general categories in which we seek input, though some recommendations may include multiple categories:

&#61623      Program Integrity Reforms to Protect Beneficiaries and Prevent Fraud and Abuse

&#61623      Payment Integrity Reforms to Ensure Accuracy, Efficiency and Value

&#61623      Fraud and Abuse Enforcement Reforms to Ensure Tougher Penalties Against Those Who Commit Fraud

 

Entities interested in submitting white papers should email a PDF or Microsoft Word document to ProgramIntegrityWhitePapers@finance.senate.gov by June 29, 2012.  Submissions should include summary information about the entity or individual submitting a white paper, as well as phone and email contact information. White papers should be as succinct and concrete as possible.  When possible, please include cost-benefit or potential savings information.  Our staff will review submissions and compile a summary document highlighting key proposals later this year.

We appreciate your submission of thoughtful and constructive solutions, as we work to conduct targeted oversight to improve federal efforts to reduce fraud and abuse in Medicare and Medicaid. Together, we believe we can improve program integrity and be better stewards of taxpayer dollars.

Sincerely,

BAUCUS
HATCH
COBURN
WYDEN
GRASSLEY
CARPER

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