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Linda Collins Blogger

Recovery Auditors Start Auditing, Again

Posted by Linda Collins | November 20, 2015

After an almost one year long hiatus, the Recovery Auditors (RA) have been given the green light to start auditing DMEPOS claims again. CMS approved the audits to begin effective November 15, 2015.

The original four auditors, divided by geographical territory, will begin audits of claims following the issues they have posted on their websites. There is a three year look back period.

At the same time the auditors begin activity, CMS will take bids for the new audit contracts. The new audit program will include:

  • Five regions instead of the original four regions. Under this new structure, DMEPOS audits for the entire country will the sole responsibility of the fifth RA. The other four regions will continue to focus on hospitals, physicians and other outpatient facilities.
  • Providers will be audited based upon denial rates. Providers with higher compliance rates (i.e. all necessary documentation) will be subject to lower audit rates going forward.
  • The Recovery Auditors will still receive a contingency fee but they will not receive actual payment until after the second level of Medicare appeals.

Those companies wishing to submit a bid must respond by December 11, 2015.  The new RA contractors are likely to be announced sometime late second quarter 2016.

What does this mean for you?

Be familiar with the current audit issues as listed on the Recovery Auditors websites.

Region A:  Performant Recovery

Region B:  CGI Federal, Inc. 

Region C:  Cotiviti 

Region D:  HealthDataInsights, Inc.

Respond quickly and efficiently to all requests for documentation. As always, utilize the Medicare appeal process if your claim is denied. And remember, Össur's strategic partner, The Audit Team, offers a Quality Assurance Review program for your practice so that you know you have the required documentation to support your claims before you file them. For only $175/claim, The Audit Team provides you a training session to ensure that you understand coverage standards, personally analyzes your documentation, and organizes it into a professional "exhibit packet" that you can easily integrate into both the claim and any necessary appeals or audit responses.

The Audit Team is not an Össur company. So unlike direct manufacturer reimbursement support offerings, you don't have to worry that it will ever give a claim the "thumbs up" in order to improve its bottom line. Rather, The Audit Team provides objective, comprehensive, and most importantly, independent reviews of suppliers' claim materials. Built on exceptional results and a collaborative, trusting relationship with its clients, The Audit Team has performed more than 20,000 Quality Assurance Reviews for DMEPOS suppliers over the last 12 months. 

For more information about The Audit Team, please email Stephanie Morgan Greene, Esq. at  SGreene@TheAuditTeam.com.

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If you have any questions for Össur’s Reimbursement Team or about Össur’s Reimbursement Services, please contact us at reimbursement411@ossur.com