Durable Medical Equipment ("DME") Suppliers Subject to RAC Audits

The Recovery Audit Contractor ("RAC") program is now a permanent program, after the RAC contractors identified significant alleged overpayments for the Centers for Medicare & Medicaid Services (“CMS”) during the RAC demonstration program. RAC reviewers, like other CMS contractors are focusing on detecting potential overpayments to DME suppliers. DME suppliers nationwide are at risk of being chosen for an audit and should prepare now for increased scrutiny of their Medicare claims.

During the RAC demonstration program, many DME supplies were denied because the items were supplied during a beneficiary's inpatient admission or Skilled Nursing Facility ("SNF") stay. This has remained an area of scrutiny among the permanent RAC reviewers and other CMS contractors. In the RAC permanent program, CMS continues to focus on DME - looking at various issues, such as multiple DME rentals in a one month period, billing for DME after the date of death, DME received while in hospice and incorrect payments of maintenance and servicing for capped DME rentals.

Other CMS areas of focus for DME suppliers include, but are not limited to, the following:

• Payments for disposable supplies 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 DME suppliers, as well as other suppliers, providers, and healthcare entities subject to Medicare audits and claim denials for over 25 years. During the RAC demonstration and permanent program, our firm has successfully represented numerous entities with their appeals of claim denials and overpayment determinations. Please contact us if you need assistance preparing for or defending an audit by the RAC or other CMS contractor.

Articles

The attorneys at Wachler & Associates often write articles addressing issues that affect hospice and home health agencies. Please visit our Audit Articles page to view a list of Wachler & Associate's audit articles.

Speeches

The attorneys of Wachler & Associates often speak on audit issues that affect hospice and home health agencies. Please visit our Audit Speaking Engagements page to view a list of Wachler & Associate's audit speaking engagements.

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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.