NHIC, the Jurisdiction A Durable Medical Equipment Medicare Administrative Contractor (DME MAC), has announced the addition of supplier self-audit tools. These tools include standardized, modular review guidelines similar to existing internal review guidelines on selected elements of payment policy such as prescriptions, refills, and proof of delivery, which have been identified as common error issues.
The Centers for Medicare & Medicaid Services (CMS) Program Integrity Manual 1.3.9 allows durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers to perform self-audits. Supplier manuals, medical policy, and educational materials provide information about Medicare payment rules, but there has been little guidance available that addresses the process of performing a claim review or provides a structured protocol that parallels the standards used in a formal Medical Review (MR) Complex Review.
The following tools are available:
- Prescription (Order) Requirements
- Proof of Delivery
- Refill Requirements
NHIC emphasized, however, that a passing result in a supplier self-audit does not guarantee the same outcome if the claim is selected for an audit. Therefore, these forms should not be submitted with your audit or appeals requests as it is not a guarantee your records are complete.
For more information, and to access the tools, visit www.medicarenhic.com/dme/selfaudits.aspx.
