The American Association for Homecare (AAHomecare) is bringing attention to a report by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), suggesting that the Centers for Medicare & Medicaid (CMS) is denying too many durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claims because of technical problems with documentation.
Tyler Wilson, president of AAHomecare, said the report shows that the documentation process for Medicare reimbursements must be addressed in a substantial way.
“Providers are paying for products and services that are medically necessary for Medicare beneficiaries,” Wilson said in an article published in AAHomecare’s Mobility Matters. “Then, largely for technical reasons, the reimbursements for providers are being denied, and they must go through a lengthy and costly appeals process to receive payment.”
AAHomecare cited a March 9 study in which the HHS OIG concluded that improper Medicare payments reported to Congress for fiscal years 2009 and 2010 should have been reduced by about $2 billion annually because thousands of denied claims cited were later overturned and paid during the appeals process.
That shows the extent of flaws in CMS reimbursement and documentation policies, AAHomecare said.
“Clearly, however, the number of successful appeals at three different levels—Medicare Administrative Contractor, Qualified Independent Contractor, and Administrative Law Judge—demonstrates that other authorities disagree with the way CMS and its contractors are reviewing claims,” the article said. “One major problem is the lack of a consistent and reasonable standard: Providers find that the policy guidelines are routinely applied differently in different regions of the country, and can even vary within the same region or claims office.”