LEEDer Group Inc.
8508 North West 66th St.
Miami, Florida 33166 USA

Phone: 305.436.5030
Fax: 305.436.0086
E-mail Address: info {at] LEEDerGroup [dot] com

2014-12 Supplier Self Audits





December 24, 2014

Supplier Self Audit Tools
  • CMS Program Integrity Manual 1.3.9 allows DMEPOS suppliers to perform self-audits. Unfortunately, most suppliers do not exercise this opportunity. Supplier manuals, medical policy, and educational materials provide information about Medicare payment rules and until now there has been little guidance available that addresses the process of performing a claim review or provides a structured protocol that parallels the standards used in a formal Medical Review (MR) Complex Review.
  • In an effort to encourage suppliers to perform Self-Audits, DME MAC A is pleased to announce the addition of Supplier Self Audit tools. These tools include standardized, modular review guidelines similar to existing internal review guidelines on selected elements of payment policy such as prescriptions, refills, and proof of delivery which have been identified as common error issues.
  • The following new tools are available under the Medical Review Section of the DME MAC A Web site
  1. Prescription (Order) Requirements
  2. Proof of Delivery
  3. Refill Requirements
  • Suppliers on their own initiative and at their discretion may choose to make use of these materials and notify the DME MAC if overpayments are identified. Keep in mind, a passing result in a supplier self-audit does not guarantee the same outcome if the claim is selected for an audit. Therefore, these forms should not be submitted with your audit or appeals requests as it is not a guarantee your records are complete.
  • In the future, DME MAC A plans to expand this initiative to include MR-Directed Self Audits. Be sure to sign up for the DME MAC A Listserve to be notified about additional modules and the expansion of this initiative.