Beware, this is just one region that has published the date of death audit for DME and inpatient facilities such as rehab, hospital, LTC, SNF facilities. This audit is done periodically and most suppliers are hit with a few thousand to upwards of $20K in overpayment refund requests. Be prepared with a reserve of cash based on the size of your business. At a minimum, I would suggest a set back of $5K even if you are outside of Region A. Region A tends to publish this type of information earlier than other areas. These audits typically take place about every three years which is why the dollar amounts are so high.
We all know that payment after date of death will never be paid; however accidents will happen. Ensure your billing staff doesn’t just “resubmit” claims without working the denial, this can cause a fraud audit even if you are not getting paid! Likewise, if payment does occur it is usually less than 90 days from date of death when family fail to contact suppliers because they think the equipment belongs to the patient. It could be a pick up ticket was not entered or a facility span date was not stopped at date of death instead of the full episode. Note these are being audited by the RAC!
Republished:
NHIC, Corp.
DME MAC A ListServe
For Immediate Release
August 12, 2010
CMS Approved Audit Issues Posted for Region A Recovery Audit Contractor
DCS, the Medicare Recovery Audit Contractor (RAC) for Region A, recently posted new CMS approved audit issues for RAC review.
The new CMS approved audit issues are listed below and apply to the states of Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.
* Date of Death – DME
* Date of Death – Inpatient
See the CMS approved audit issues at DCS’ RAC website: http://www.DCSRAC.com for more information.
Region A includes the states of Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.