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Medicare Audits Are Coming!!! Medicare Audits Are Coming!!!


In the July 2020, Coronavirus Disease 2019 (COVID -19) Provider Burden Relief Frequently Asked Questions (FAQs), CMS stated that the Medicare Fee-For-Service (FTS) medical review suspension that was announced on March 30th, which include TPE audits, SMRC audits, and RAC audits, expects to discontinue the suspension beginning on August 3, 2020. See the FAQ here.


While CMS suggests that there may be some regulatory leeway for COVID-19 impacts, they do not clarify what qualifies and what regulatory leeway they will provide. For this reason, Boost Advisory Group is urging their clients and reader of this article to use these next 25 days wisely to prepare for an onslaught of audit activity.


Who should be most concerned? Well, almost everyone but we feel that the following areas are likely to be the most targeted areas:

1. DME Businesses that were already in an active TPE, SMRC, and/or a RAC audit at the time the suspension was announced.

2. Those DME businesses that received notice that they were about to enter a medical review audit.

3. Those DME companies that provide items that are on the OIG or CMS workplan

4. Those DME companies that provide items that possess historically elevated audit activities. Such as Orthoses, Urology, CGM, Surgical Supplies, etc.

5. Those companies that have elevated denial rates that could/will trigger a TPE audit.


So, what steps can you take to prepare for elevated Medicare audit activity; and in fact, prepare to win your Medicare audits? These five steps will make a world of difference.


1. Review all quality control and documentation processes and procedures

2. Review denial rates, denial reasons, and determine how you can improve your bill and collect rates.

3. Conduct a proactive audit of your files to identify gaps and areas of opportunity

4. Utilize your proactive audit findings to correct files that have missing elements

5. Consider effective unbilled revenue management techniques so you are not releasing claims to be billed that are not audit proof-especially if you are in one of the 5 likely targeted groups above.


Now is your time to act and ensure you are ready for the likely onslaught of Medicare audit activity that will commence shortly after August 3, 2020. If you have any questions, comments, concerns or would like to take advantage of our FREE 30 minute phone consultations, please feel free to contact us at 888-394-2480, ext. 1011 or you can email us your questions at info@boost-llc.com.

About the Author:

Michael Breslin is the EVP at Boost Advisory Group, a leading Medicare audit response expert in the DME industry. Boost provides effective Medicare audit and compliance guidance in a complex regulatory environment and saves its customers significant amounts of money by saving their clients exorbitant attorney fees.


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Boost Advisory Group are experts in DME consulting, DME revenue optimization, Brightree consulting and optimization, DME business process outsourcing, Medicare TPE, RAC, and UPIC audit response services, executive coaching, operational development, Analytics and reporting optimization to improve topline and bottom line. We are experts in helping our clients grow their business by reaching operational and financial excellence.

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