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Can Real-Time Data Audit-Proof Your HME Business?

Written by: Kimberly Commito on Monday, February 27, 2017 Posted in: HME/DME

Now that Tom Price has been confirmed as the Trump Administration’s new secretary of the U.S. Department of Health & Human Services (HHS), there may be hope for fewer denials and post-payment audits in healthcare. For home and durable medical equipment providers, who seem especially scrutinized by an array of audit contractors, Price’s plan could prove to be a welcome change.

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More data, less medical necessity

During hearings prior to his confirmation, Price suggested that, under his leadership, efforts to curb Medicare fraud and abuse would shift away from determinations of medical necessity and, instead, focus more on the intentional acts of fraud. He added that he would ferret out the “bad actors” using real-time data rather than post-payment audits. “In every other industry, real-time information is available and acted upon,” Price said, whereas CMS often pays first and then attempts to reclaim what is later deemed to have been inappropriate payment.

So instead of that approach, Price seems to be recommending that CMS focus even more on its data mining tools to look for outliers to determine improper or excessive billing. The result, he added, would be that “instead of trying to determine whether every single incident of care is necessary … we could do a much better job of not just identifying the fraud that exists but ending that fraud.”

Make the data work for you

Hopefully, this means that, under Price’s leadership, healthcare providers will be able to rely on accurate coding and billing to minimize denials and audits. For example, our CareTend system incorporates quality checks that prevent users from proceeding until all mandatory fields are completed. This way, your billing is accurate and raises no red flags for CMS.

In addition, if you should experience denials, the system helps you examine why your claims were denied, so you can correct the errors and avoid making them again in the future. This will be especially important as CMS relies more heavily on data mining techniques to look for patterns of improper billing or excessive billing of particular codes compared to your peers.

While a new focus on real-time data isn’t likely to prevent audits altogether, your reliable HME/DME software system can help ensure that the data you provide to CMS is accurate. And this should help keep you off the radar of the Medicare Fraud Strike Force or the Health Care Fraud Prevention and Enforcement Action Team (HEAT).


Confirmation Hearing for HHS Secretary Tom Price;

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