Durable Medical Equipment (“DME”) Suppliers Subject to RAC Audits
The Recovery Audit Contractor (“RAC”) program will be operating in numerous states this year, and will be nationwide by 2010. Durable Medical Equipment (“DME”) suppliers nationwide should prepare now for increased scrutiny of their Medicare claims, as the Centers for Medicare and Medicaid Services (“CMS”) has announced its intention to focus audit activities upon DME suppliers and Home Health Agencies (“HHAs”).
Although the areas that will be subject to review during the RAC program cannot be predicted with certainty, reviewing the categories of claims denied during the RAC demonstration program, and reviewing other CMS guidance, can assist DME companies to determine potential areas of RAC scrutiny.
During the RAC demonstration program, many DME supplies were denied because the items were supplied during a beneficiary’s inpatient admissions or Skilled Nursing Facility (“SNF”) stay. This will likely remain an area of Medicare scrutiny as the RAC program expands nationwide.
Other CMS areas of focus for DME suppliers include, but are not limited to, the following:
- DME payments for beneficiaries receiving Home Health Agency (“HHA”) services;
- Medicare Part B payments for home blood glucose testing supplies;
- Appropriateness of reimbursement for pressure-reducing support surfaces; and
- Appropriateness of reimbursement for power wheelchairs.
DME suppliers must prepare now for increased Medicare scrutiny of these and other types of claims.
Wachler & Associates, P.C., has represented providers, suppliers and other healthcare entities subject to Medicare audits and claim denials for over 20 years. During the RAC demonstration program, our firm successfully represented numerous entities with their appeals of claim denials and overpayment determinations.
Publications
"The RACs are Coming - Are You Ready?" co-author Andrew B. Wachler, Esq., Member Briefing: American Health Lawyers Association Hospitals and Health Systems Practice Group, January 2009.
"RAC to the Future: What Can Medicare Providers and Suppliers Expect from the Recovery Audit Contractor Program?" co-author Andrew B. Wachler, Esq., The Health Lawyer, The ABA Health Law Section, Vol. 21, No. 2, December, 2008.
"The RACs Are Coming - Are You Ready?" co-author Andrew B. Wachler, Esq., The RAP Sheet, American Health Lawyers Association, Regulation, Accreditation and Payment Practice Group, December 2008.
"Recovery Audit Contractors and Medicare Audits: Successful Strategies for Preparing for and Defending Audits," co-author Andrew B. Wachler, Esq., Journal of Health Care Compliance, September-October, 2008.
"The Medicare Appeals Process and Strategies for Successful Appeals," co-author Andrew B. Wachler, Esq., American Health Lawyers Association, Physician Organizations, Vol. 10, Issue 1, Winter, 2007.
"Get Ready: The RACs May Be Nationwide Sooner Than Expected!" co-author Andrew B. Wachler, Esq., HCCA Compliance Today, 2007.
"The New Medicare Part A and Part B Appeals Process," co-author Andrew B. Wachler, Esq., Health Law Handbook 2006, Part I, Chapter I, 2006.
"The New Medicare Appeals Process," co-author Andrew B. Wachler, Esq., The Health Lawyer, The ABA Health Law Section, June 2005.
Speaking Engagements
"RACs & Medicare Audits: Compliance Tips and Successful Appeals Strategy," Annual Meeting of the National Association of Home Care & Hospice (NAHC), October 10, 2009 - October 14, 2009.
"Latest Developments Related to the Nationwide Expansion of the Recovery Audit Contractors," State Bar of Michigan Health Care Law Section Annual Meeting, September 24, 2009.
"Recovery Audit Contractors," 2nd National RAC Summit, September 14, 2009 - September 15, 2009.
"Recovery Audit Contractors and Medicare Audits: Compliance Tips and Successful Appeals Strategies," Indiana Association for Home & Hospice Care (IAHHC), May 19, 2009 - May 21, 2009.
"RACs & Medicare Audits: Compliance Tips and Successful Appeals Strategy," Indiana Association for Home & Hospice Care, May 19, 2009 - May 21, 2009.
"RACs: Appeals Strategies," Health Business Management Association (HBMA) 2009 Spring Education Conference, May 6, 2009 - May 8, 2009.
"RAC Audit Appeals- Strategies and Defenses for Overturning Hospital RAC Denials," National Healthcare Compliance Audioconference, May 5, 2009
"Ready or Not, Here They Come! Preparing for and Defending the RACS," (HCCA) 13th Annual Compliance Institute, April 26, 2009 - April 29, 2009.
"Advanced Appeals Workshop," 2009 American Health Lawyers Association (AHLA) Institute on Medicare and Medicaid Payment Issues, March 25, 2009 - March 27, 2009.
"The Basics: How the RAC Appeals Process Works," National Medicare RAC Summit, March 5, 2009 - March 6, 2009.
"Recovery Audit Contractors and Medicare Audits," 2009 American Bar Association (ABA) Emerging Issues Conference, February 18, 2009 - February 20, 2009.
"Managing the Recovery Audit Contractor Review Process," World Research Group, December 8, 2008 - December 9, 2008.
"Recovery Audit Contractors: Past, Present and the Future," 2008 ABA Health Care Law Section Washington Summit, November 17, 2008 - November 18, 2008 (with Melanie Combs-Dyer, senior technical adviser for CMS' division of recovery audit operations).
Contact Us
Call us at 248-544-0888 or send us an e-mail to schedule a meeting to discuss your concerns with RACs or to address your other healthcare law-related needs.
