CMS admits error in recovery audit process

Reimbursement can be a tough area to understand completely. Constant changes in requirements ad a bureaucratic system that often does not communicate well internally mistakes do get made from time to time.  CMS editor Theresa Flaherty reports this morning

“Medicare policy requires an approved sleep test for CPAP and supplies. HDI, the recovery audit contractor (RAC) for Noridian Administrative Services, the Jurisdiction D DME MAC, interpreted that to mean that Medicare must pay for the test.

In reality, “it doesn’t matter who pays for the sleep test,” said Kelly Riley, director of The MED Group’s National Respiratory Network, and a member of AAHomecare’s CPAP Task Force.

HDI was demanding recoupment on claims where Medicare didn’t pay for the sleep test.”

This has impacted small HME providers throughout Jurisdiction D in increased costs and difficulty providing patient care. While this issue is not resolved I am sure claims are now being reviewed for a second time to now comply with actual CMS regulations.

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Randy Clare

Randy Clare

Randy Clare brings to The Sleep and Respiratory Scholar more than 25 years of extensive knowledge and experience in the sleep and pulmonary function field. He has held numerous management positions throughout his career and has demonstrated a unique view of the alternate care diagnostic and therapy model. He is considered by many an expert in the use of a Sleep Bruxism Monitor in a dental office. Mr. Clare's extensive sleep industry experience assists Sleepandrespiratoryscholar in providing current, relevant, data-proven information on sleep diagnostics and sleep therapies that are effective for the treatment of sleep disorders. Mr Clare is a senior brand manager for Glidewell Dental Laboratory his focus is on dental treatment for sleep disordered breathing.

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