Audit Tracking Tool Shows 98 Percent Appeal Rate for O&P

Data collected by the American Association for Homecare (AAHomecare) Audit Key for the fourth quarter of 2015 found that 16 percent of O&P claims for new patients were subject to prepayment audits by Durable Medical Equipment Medicare Administrative Contractors (DME MACs), and 98 percent of those claims were appealed. After additional documentation requests, 15 percent of the appealed claims were subsequently paid. AAHomecare, an advocacy group that represents healthcare providers, equipment manufacturers, and other organizations in the homecare community, developed the Home Medical Equipment (HME) Audit Key to track data about audits in HME, which includes durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

On average, 12 percent of HME claims for new patients were subject to DME MAC prepayment audits during this same time period, according to the data. Nationwide, 78 percent of providers appealed denials. In other HME product categories, 22 percent of hospital beds, support surfaces, and manual wheelchair claims were subject to audits and 60 percent were subsequently paid. For respiratory equipment, 14 percent were audited and 74 percent of appealed claims were paid.

"The HME industry needs reliable and representative data to better demonstrate the burdensome nature of audits," the association was quoted as saying by HME News. "We must build our capabilities to accurately detail how the industry is being impacted to finally secure much-needed reform to the audit process. These results are a first step in a comprehensive effort to collect data that demonstrates the burdensome nature of audits, in terms of volumes and overturn rates."

To register with and submit data to HME Audit Key, visit www.hmeauditkey.org. For more information about the latest HME Audit Key findings, click on the Results tab at the top of that website.