Audit Update: A Different Kind of Pandemic
(Room C203)
19 Oct 21
1:00 PM
-
2:00 PM
Tracks:
Business Operations (Conference Pass Only)
With the COVID pandemic mostly behind us, the question becomes what will CMS and its contractors do as far as audits go? CMS has hinted all along that they intend to audit claims submitted during the PHE but have not been real clear on what parameters they will review by and suppliers do not know what to expect. In addition, the ALJ backlog is expected to be resolved by the end of 2021 which is a good thing; however, the Office of Medicare Hearings and Appeals hired 70 new judges and opened up numerous new offices around the country with a much larger budget than they had before. Once the backlog is resolved, they will be staffed to handle up to 300,000 appeals annually. The problem is they are receiving nowhere near that right now, so does that give CMS a green light to open the floodgate to the RAC auditors? This presentation will provide inside from audit experts Wayne van Halem and Kelly Grahovac and share thoughts gleaned from interactions with CMS and its contractors.