Post-PHE: Brush Up on Rules to Guard Against Audits

Published in Government Relations on June 28, 2023

This article was originally featured in HME News

With the public health emergency officially over, HME providers need to prepare for a return to “normal” – including a return to audits, say industry stakeholders. 

On April 28, ahead of the PHE ending on May 11, CMS published directions for claims impacted by the COVID-19 pandemic. Among the agency’s guidance: Continue to use the CR modifier for rentals and supplies, and return to proof of delivery with a patient’s signature. 

“During the pandemic, there were patients that said, ‘I’m not going to sign that delivery ticket,’ so the supplier used COVID-19 as the signature and used the CR modifier when they billed the claim,” said Ronda Buhrmester, senior director of payer relations and reimbursement for VGM & Associates. “Post-PHE, that COVID signature is no longer allowed.” 

Stakeholders fully believe that claims with CR modifiers will be subject to scrutiny, so Dan Fedor, national director of coding and reimbursement for U.S. Rehab, recommend providers “do a recount and make sure they have what they need.” 

“It’s confusing,” he said. “There’s a lot of changes, a lot of waivers. Normal policy is confusing and then add in this. Providers need to make sure they are 100% prepared, not 90% prepared.” 

Another area where stakeholders expect auditors to be thorough: telehealth visits. While CMS has extended flexibilities around telehealth through Dec. 31, 2024, and while there was leniency during the PHE for treating practitioners to conduct audio-only visits, DME providers now need to make sure visits include audio and visual to bill these claims, stakeholders say. 

“Auditing groups are really going to be looking at those claims to make sure they meet the coverage criteria,” she said. 

Buhrmester recommends providers archive articles and FAQs put out by CMS in their own forms library. 

“Download it now so whenever those audits happen, whether it’s now, one year or two years, you’ll have that information,” she said.