WASHINGTON, D.C. – As mentioned in a July 10 alert, CMS announced in the Coronavirus Disease 2019 (COVID-19) Provider Burden Relief Frequently Asked Questions (FAQs) that the suspension of Medicare FFS audits due to the COVID-19 Public Health Emergency (PHE) will be lifted beginning August 3, 2020. Due to state reopenings and the importance of program integrity, CMS will be restarting reviews from DME MACs, RAC, and SMRC that were previously suspended in March 2020.
In a recent conversation with CMS, AAHomecare shared industry concerns with this announcement. With many offices still closed and COVID-19 cases increasing, suppliers will have difficulty responding to audit requests. While the PHE is still in place, the priority for suppliers is on providing care to patients and suppliers should not be incumbered by large volumes of audits.
CMS understood these concerns and to ease the burden on suppliers, CMS clarified that audit activity will not fully resume on August 3. To accommodate suppliers, audits will begin with DME MAC post-pay reviews which will allow for more flexibility than pre-pay reviews and will not hold up payments to suppliers.
CMS shared that TPE audits are not included in this roll out of audits and at this stage, there is no timeline for TPEs to be restarted. DME MACs may allow extensions and the cancelling of an audit based on suppliers ability to complete the audit. Currently, there is also no timeline set to restart RAC or SMRC audits.
CMS also shared that audits would start on a delayed timeframe and suppliers should not expect audit requests on August 3. CMS indicated that DME MACs will not be auditing claims started during the PHE at this point. The DME MACs will be pulling claims from sometime prior to March 1, 2020. CMS is tracking state and county-level COVID-19 case data and sharing this information with the MACs to be taken into consideration.
We thank CMS for taking the time to discuss DMEPOS industry concerns and providing insight into their approach with this change. While we do not support going back to normal audit activity during the pandemic, we appreciate CMS’ approach to resume program integrity activities in phases.
AAHomecare will be monitoring this rollout and will inform membership as new information is presented. In the meantime, we encourage membership to stay informed on new developments with COVID-19 waivers by visiting CMS’ Current Emergencies website and AAHomecare’s COVID-19 Resources page.
