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Time Business News
2 days ago
- Health
- Time Business News
Navigating DME Billing Audits: Best Practices for Providers
Durable medical equipment (DME) suppliers and provider offices face an increasingly scrutinized reimbursement environment. Audits — whether from Recovery Audit Contractors (RACs), Medicare Administrative Contractors (MACs), Office of Inspector General (OIG), or private payers — target documentation gaps, improper enrollment, billing mistakes, and non-compliance with DMEPOS supplier standards. This article gives providers an actionable roadmap to reduce risk, respond effectively when audited, and build durable compliance processes. Medicare and related programs continue to refine oversight of DME claims. Recent updates to the DMEPOS quality standards, continuing OIG findings of improper payments, and active MAC/RAC programs mean that suppliers who rely on old processes risk costly recoupments and loss of billing privileges. Staying current with CMS guidance and audit trends is not optional — it's central to financial and regulatory health. Understanding what draws attention helps you prioritize controls. Typical triggers include: Missing or incomplete Standard Written Orders (SWOs) and supporting medical records. Inadequate proof of delivery (POD) or beneficiary authorization. Non-compliance with updated DMEPOS supplier standards (accreditation, patient training, servicing). Incorrect coding, units, or billing for items excluded by the Master List or specific policy. Billing during inpatient stays or hospice periods when Medicare rules prohibit payment — a frequent OIG finding. Preventing large-scale recoupments starts with pragmatic, repeatable controls you can implement today. Tighten enrollment and supplier credentials. Maintain current PECOS enrollment, NPI/Taxonomy data, and DMEPOS accreditation records. CMS enrollment errors and lapsed accreditation are immediate grounds for payment suspension. Standardize documentation at the point of intake. Create mandatory intake checklists that capture SWO, referring provider details, medical necessity rationale, beneficiary signature/authorization, and delivery/POD info. Store these documents in searchable, time-stamped electronic records. Refer to DME MAC and MAC-region checklists for the exact documentation required by item. Map clinical criteria to billing codes. Maintain a brief clinical-to-code map for high-risk items (power mobility devices, oxygen, complex rehabilitative equipment). Cross-reference the CMS Master List and product-specific service requirements to avoid billing excluded items or insufficiently documented claims. Train staff regularly and test knowledge. Front-line intake staff and billers should receive quarterly refreshers on SWO requirements, proof of delivery, and beneficiary authorizations. Run periodic chart audits to identify recurring documentation gaps before an external auditor does. Use technology for retention and retrieval. Implement a records-retention policy aligned with CMS and MAC guidance, and employ searchable EHR or document management solutions so you can respond to Additional Documentation Requests (ADRs) promptly. Even the best-prepared suppliers get audited. What matters is your response. Acknowledge and triage immediately. Confirm the identity of the auditor and the scope of the request. Only accept legitimate requests through the channels specified by CMS or your MAC; beware of phishing. (MAC and CMS websites list legitimate communications.) Assemble a response team. Assign a lead (compliance officer or senior manager), the biller who handled the claim, the clinician for clinical questions, and legal or external counsel if exposure is large. Keep communications centralized and documented. Prioritize requests using risk and volume. Start with high-value claims and any items where policy is explicit (e.g., power mobility device repairs, oxygen). OIG audits frequently flag expensive categories; tackle these first. Provide exactly what's requested — no more, no less. Over-sharing may create new lines of inquiry. Prepare a clean, indexed package. For ADRs from RACs or MACs, respond within the stated timeframe and follow the ADR formatting guidance on the MAC portal. Document every interaction. Log phone calls, emails, uploads, and internal decisions. If you make voluntary refunds or adjustments, do so through standard claim adjustment procedures and preserve evidence of the action. If you disagree with a determination, use the MAC/RAC appeals process. Common successful appeals hinge on clear documentation that proves medical necessity or corrects a misunderstanding (e.g., updated SWO vs. original claim). If systemic issues caused the denial, quickly implement corrective action plans and document training/controls to mitigate further liability. One-time fixes are insufficient. Build an audit-ready culture: Monthly internal audits: Sample claims, focusing on top revenue items and recent policy changes. Sample claims, focusing on top revenue items and recent policy changes. Policy watch: Assign responsibility to monitor CMS, MAC, and OIG publications for new guidance or audit trends. (Subscribe to MAC listservs; CMS posts DMEPOS rules and updates.) Assign responsibility to monitor CMS, MAC, and OIG publications for new guidance or audit trends. (Subscribe to MAC listservs; CMS posts DMEPOS rules and updates.) Key performance indicators (KPIs): Track ADR turnaround time, percent of claims with complete SWOs, and audit recoupment dollars by month. Track ADR turnaround time, percent of claims with complete SWOs, and audit recoupment dollars by month. External reviews: Consider an annual external compliance audit or targeted coding review from a specialist familiar with DME audits. If you use third-party billers or clinicians who order DME, ensure contracts require compliance with documentation standards and give you audit access to records. Outsourced relationships remain your responsibility — vendors must conform to your policies and respond under your oversight. If you're evaluating dme billing services, require proof of experience with MAC/RAC audits, sample documentation processes, and references. (One clear performance condition: how they handle ADRs and appeals.) OIG and CMS audits consistently reveal a few recurring themes: lack of clinical justification, insufficient proof of delivery, billing during excluded periods (inpatient/hospice), and failure to meet product-specific requirements. These are actionable — close those gaps and you materially reduce audit exposure. Confirm PECOS enrollment and DMEPOS accreditation are active and documentation stored. Run a four-week sample audit of high-risk codes and correct deficiencies. Update intake checklists to always capture SWO, beneficiary authorization, and POD. Subscribe to your MAC's updates and the CMS DMEPOS quality standards page; assign someone to review and summarize changes weekly. Navigating DME billing audits requires a mix of tactical readiness and strategic change. By standardizing documentation, training staff, using technology for retention and quick retrieval, and staying current with CMS/MAC/OIG guidance, providers can turn audits from existential threats into manageable compliance events. The more you anticipate audit triggers and institutionalize best practices, the less disruptive — and costly — an audit will be. TIME BUSINESS NEWS
CBS News
6 days ago
- Health
- CBS News
Staffing shortages at VA health systems are on the rise, watchdog finds
Health care staffing shortages at the Department of Veterans Affairs are on the rise, according to a new watchdog report. In the report, out Tuesday, the VA's Office of Inspector General, or OIG, found Veterans Health Administration facilities reported 4,434 staffing shortages this fiscal year, which is a 50% increase from fiscal year 2024. Almost all — 94% — of facilities reported severe shortages for medical officers, while 79% of facilities reported severe shortages for nurses, according to the report. The report's data comes from questionnaires sent to 139 VHA facilities, comparing 2025 responses to 2018-2024 responses. The 2025 questionnaires were distributed via email on March 26 with a required completion date of April 9. Data on staffing shortages at VA facilities has been collected annually for over a decade, and the report notes that this is the eighth report to identify severe occupational staffing shortages at the facility level. The report notes that the OIG did not independently verify VHA data for accuracy or completeness. It also says that due to the timing of the questionnaire, any impact on staffing from OPM's Deferred Resignation Program and VA's workforce reshaping efforts — which are expected to lead to further staffing shortages — were not fully reflected. In response to the report, Pete Kasperowicz, press secretary for the U.S. Department of Veterans Affairs, said it is "not based on actual VA health care facility vacancies and therefore is not a reliable indicator of staffing shortages." "The report simply lists occupations facilities feel are difficult for which to recruit and retain, so the results are completely subjective, not standardized and unreliable," he said in an emailed statement to CBS News on Wednesday. "VA's department-wide vacancy rates for doctors and nurses are 14% and 10%, respectively. These are lower than most other health care systems, in line with normal VA historical averages and much lower than the respective 19% and 20% physician and nurse vacancy rates VA saw at times during the Biden Administration." CBS News has reached out to the OIG's office seeking a response to Kasperowicz's statement. Others criticized the Trump administration after the findings. Sen. Mark Warner, a Virginia Democrat, said, "Under this administration, we've seen policy after policy that makes it harder for public servants to do their jobs and ultimately harder for veterans to get the care they've earned." "We also know from recent jobs reports that applications to work at the VA are plummeting. How do skyrocketing staffing shortages and declining applicant pools make it more 'efficient' for veterans to access the care and services they deserve? The answer is: they don't," Warner said in a statement. "If the administration is serious about honoring our veterans, it needs to stop undermining the VA workforce and start recruiting and retaining the skilled professionals who care for our heroes." Among the VHA facilities surveyed this year, at least 20% reported severe staffing shortages for more than 40 occupations — marking the highest number of job shortages reported since 2018, according to the report. Severe staffing shortages were also reported for psychologists at 57% of VHA facilities. For non-clinical positions, the highest reported shortage was for police officers, which about 58% of facilities reported.
CBS News
16-07-2025
- Health
- CBS News
Persistent heat issues disrupted operations at Baltimore sexual health clinic, OIG report says
Persistent heat issues disrupted operations at a Baltimore sexual health clinic, according to an OIG report. The report follows observations made by the OIG on June 24 during a site visit to the Druid Sexual Health Clinic in West Baltimore. On the day of the visit, Baltimore City was under a Code Red Extreme Heat Alert. The OIG said several staff office rooms were not in use because it was too hot. Multiple employees commented that it was too hot in the building to work and that the building has a malfunctioning HVAC system, according to the report. As a result, temperatures inside the clinic can become extremely hot. One staff member told the OIG that the computer server room at the facility, which was supposed to be kept at 70°F, had overheated multiple times, causing the electricity to go out. According to staff members, a walkthrough by the Department of General Services was conducted a week prior to the OIG's visit to evaluate the possibility of installing air conditioning. On occasions when the Druid Clinic overheated, operations at the facility are shut down and moved to the Eastern Clinic on East Fayette Street, according to an employee. Staff members said this often happens between May and September due to the heat. As a result, the facility often has unscheduled closures that impact clinic patients when their appointments are unexpectedly canceled, or when the clinic is unable to take walk-ins. But the OIG's concerns weren't limited to the conditions for employees and facilities. Several employees at the clinic alleged that on multiple occasions, rapid testing for Human Immunodeficiency Virus (HIV) and Hepatitis C (HCV) was halted due to high building temperatures. Some of the HIV and HCV test kits expired and were no longer able to be used for patients, according to the Baltimore City Health Department. The report notes that testing was stopped when indoor temperatures reached 29°C (approximately 84-85°F), exceeding the storage range recommended by the test kit manufacturers. According to the OIG, rapid HIV tests are recommended to be stored between 35°F and 80°F, while HCV test kits require 36°F to 86°F. The OIG has inspected the Druid Clinic before and found evidence of security issues, rodents, pests, and general maintenance issues, the office said. The BCHD deputy commissioner told the OIG that the department is aware of the concerns with the building and that the Druid SHC is the next building slated to receive funding for renovations. The commissioner is also reviewing the possibility of purchasing a different building and moving SHC operations there, per the report. The Baltimore City Health Department issued a response to the OIG. "BCHD has been aware of the infrastructure and operational challenges and concerns raised by staff for some time. Accordingly, we work regularly with the Department of General Services (DGS) to address them, when necessary, which is often," the health department said in part. The department acknowledged that the HVAC system and building are deteriorating, and said the building needs full HVAC system replacement.
Forbes
11-07-2025
- Forbes
Office Of The Inspector General's Report On Federal Prison Restraints
Office of Inspector General cited concerns over how the Bureau of Prisons restrains certain inmates ... More in its facilities. Use of Restraints The Department of Justice's Office of the Inspector General (OIG) issued a report on the Federal Bureau of Prisons (BOP) policies and practices in using restraints on inmates. The OIG's investigation into allegations made by inmates at various BOP institutions revealed that inmates were placed in restraints for prolonged periods while being confined to beds or chairs. Some inmates suffered severe or long-term injuries, such as the amputation of a limb after being restrained for over two days. The OIG found that shortcomings in BOP's policies and practices contributed to these issues, limiting evidence availability and impairing investigations into potential misconduct by BOP staff. Identified Shortcomings in BOP's Use of Restraints The investigation into the BOP's use of restraints revealed significant issues that compromise inmate safety and well-being. These include a lack of clear definitions and guidance regarding terms like "four-point restraints" and inadequate instructions for the necessary medical and psychological checks. BOP policies also permit prolonged use of restraints without sufficient oversight, resulting in injuries such as nerve damage and scarring. Additionally, the documentation of restraint checks is often insufficient, with no requirements for video or audio recordings to support or dispute inmate claims of mistreatment. Furthermore, while medical and psychological assessments are required, there is inconsistent documentation and follow-up regarding inmates' injuries or health concerns. Relevant BOP Policies and Regulations The BOP's use of force and restraint policies are outlined in the BOP's program statement 5566, and the applicable regulations are codified in 28 C.F.R. § 552. These policies state that force, including restraints, should only be used as a last resort when all other efforts to resolve a situation have failed. However, the BOP had run into issues with restraints in 2023 when USP Thomson was suddenly closed over abuses uncovered in its Special Management Unit (SMU). According to a study by The Washington Lawyers' Committee for Civil Rights & Urban Affairs, inmates were subjected to prolonged use of four-point restraints. Psychological abuse was also rampant, including extended solitary confinement, racial slurs, and deliberate placement with dangerous cellmates. Staff often denied mental health care to vulnerable individuals, exacerbating their conditions. These practices, which were described as pervasive torture, continued even after the closure of the Thomson SMU in 2023. Concerns Regarding Prolonged Restraint Use One of the primary issues raised by the OIG is the BOP's failure to limit the duration of time an inmate can be kept in restraints, particularly in extreme cases like four-point restraints. According to the Use of Force Policy, inmates must be checked every 15 minutes by correctional officers, every two hours by a lieutenant, and twice per 8-hour shift by medical staff. However, the OIG found that restraints were often applied for extended periods without appropriate interventions, with some inmates being kept in restraints for over a week. This prolonged use has been linked to significant physical harm, such as nerve damage and injuries requiring medical attention. The OIG also found a lack of clarity in the BOP's guidelines about how long restraints should be applied, which is particularly concerning for inmates with mental health or self-harm issues. Deficiencies in Medical and Mental Health Oversight The OIG's review also highlighted significant deficiencies in the medical and psychological assessments of inmates in restraints. Although the BOP mandates medical assessments for inmates placed in four-point restraints, the OIG found that these assessments were often insufficient and lacked detailed documentation. In addition, medical checks, particularly those performed after the initial assessment, were not always video recorded, nor were the injuries adequately documented. The OIG also noted that BOP's medical and psychological staff may not always be well-equipped to identify injuries that result from prolonged restraint, such as nerve or muscle damage. In one case, an inmate's injury worsened to the point of requiring amputation, despite the fact that medical checks were being performed. Policy Gaps in Restraint Documentation and Review Procedures The OIG found that the BOP's documentation of restraint checks was often inadequate. The 15-minute checks were sometimes minimal and lacked sufficient detail to assess whether the inmate's welfare was being appropriately monitored. For example, in some cases, the only notes in the records were vague descriptions like "inmate manipulating restraints" or "inmate unresponsive." The OIG believes that these check forms need to include more comprehensive information about the inmate's condition and behavior to help determine whether restraints should be continued. Furthermore, the lack of video or audio recordings of restraint checks limits the OIG's ability to investigate claims of mistreatment and misconduct. The OIG has recommended that the BOP implement video and audio recording of all restraint checks to ensure that both the welfare of the inmate and the actions of the staff are properly documented. Concerns Regarding Psychological Support for Inmates in Restraints The OIG expressed concern about the psychological support available to inmates placed in restraints, especially those with mental health issues. While the BOP's Use of Force Policy requires that inmates in four-point restraints be seen by Psychology Services at least once every 24 hours, the OIG found that in practice, these visits were infrequent and inadequate. In some cases, inmates who had attempted suicide or engaged in self-harm were restrained for extended periods without sufficient mental health intervention. The OIG stressed the importance of more frequent psychological assessments for inmates in restraints, particularly those with severe mental health issues. Recommendations for BOP Policy Revisions In response to the identified concerns, the OIG has recommended several key revisions to the BOP's restraint policies and practices. These include providing clearer definitions and guidelines for restraint types, including medical, psychological, and behavioral checks. The OIG also suggests limiting the duration of restraints to prevent physical harm and unnecessary exposure to prolonged restraint. Additionally, the OIG recommends improved documentation of restraint checks, with more detailed information about inmates' behavior and welfare, and the requirement for video and audio recordings for accountability. Enhanced medical and psychological assessments, especially for inmates with mental health issues, are also advised. Finally, the OIG calls for greater involvement of regional staff to oversee restraints and offer an objective perspective on their continued use. Response The OIG's investigation into the use of restraints by the BOP has highlighted significant issues regarding the prolonged use of restraints, inadequate medical and psychological assessments, and insufficient documentation of restraint checks. BOP Director William Marshall III provided an initial statement in response to OIG's report deficiencies stating, 'The BOP is committed to addressing these issues and implementing meaningful improvements and views OIG's recommendations as a crucial oppo1tunity to enhance agency practices and ensure the humane treatment of all inmates. As noted in OIG's MAM, BOP 's statutory duty is to provide for the safekeeping and protection of inmates, and this duty is integral to the agency's mission.' I reached out to the American Civil Liberties Union (ACLU) regarding OIG's report and Maria Morris, senior staff attorney at the ACLU's National Prison Project, provided the following statement: "The use of four-point restraints for hours on end, sometimes resulting in serious and permanent injury, is the latest example of the cruelty that has come to define conditions in the Federal Bureau of Prisons. This type of abuse is unconstitutional and unacceptable, and it underscores exactly why robust oversight is essential. With President Trump threatening to gut federal accountability mechanisms, we're facing a dangerous moment where this kind of brutality could become even more common and even harder to uncover and stop."
Chicago Tribune
10-07-2025
- Politics
- Chicago Tribune
Deborah Witzburg: Chicago's City Council must protect the inspector general from political influence
Chicago's City Council will soon consider a critical ordinance that would protect the effectiveness and independence of the Chicago Office of Inspector General. OIG is a nonpartisan watchdog for city taxpayers, charged with ensuring economy, effectiveness, efficiency and integrity in the operations of city government. As with all inspector general work, independence is the hallmark and the lifeblood of what we do. Our work must be protected from political influence or interference so that we can root out misconduct and mismanagement — in a city government with a prodigious history of both — without fear or favor. The ordinance would make important changes to the Municipal Code to bring Chicago into line with national standards and federal law on independent oversight. Specifically, the proposed changes would ensure that city attorneys cannot withhold relevant evidence from OIG investigations and would prohibit city attorneys from sitting in on confidential OIG investigative interviews. City Hall has improperly asserted attorney-client privilege to withhold evidence in numerous investigations during my tenure as inspector general. OIG needs full access to city records to conduct thorough investigations, and all city officials and employees are required by law to cooperate in OIG investigations, including by providing full access to those records. This is a long-resolved issue at the federal level; inspectors general for federal agencies (including, for example, the Department of Defense and the Department of Justice) are entitled to access their agencies' records that would be protected by attorney-client privilege from disclosure to a third party. The Association of Inspectors General, the national standard-setting and certifying body for inspectors general, has issued a position paper stating that improperly blocking access to privileged records — just as the city is doing — impairs independent oversight and contravenes national standards. The pending ordinance would also clarify the Municipal Code to protect the confidentiality of OIG investigations, including to protect whistleblowers and witnesses from personal and political retaliation, by making clear that city lawyers may not sit in on confidential investigative interviews. When OIG interviews a person who is subject to an investigation, that person is entitled to have their lawyer in the room. The mayor, however, is not entitled to have his lawyer in the room. The presence of city attorneys in OIG investigative interviews would compromise confidentiality and chill candid testimony; I will not ask city employees to fulfill their duties to report misconduct and to cooperate with our investigations while being monitored by the mayor's lawyers. Here, too, national standards are clear: The national body has also issued a position paper stating that attorneys representing the overseen agency cannot properly be permitted to attend confidential investigative interviews. During my tenure as inspector general, the city's Law Department has repeatedly demanded to attend interviews in investigations, including ones into allegations of bribery, retaliation via the withholding of city services and retaliation against individuals who made protected reports to OIG, as well as an allegation that a now-former elected official violated ethics rules by soliciting political contributions from city employees. Because I will not permit City Hall to compromise the confidentiality and independence of OIG investigations, these demands have resulted in the cancellation of interviews and the near-certain loss of relevant evidence. The reforms proposed in this ordinance are critical measures, drawn directly from national best practices, to protect OIG's ability to carry out its mission without obstruction or interference from City Hall. This is an effort to bring Chicago out of the backwoods of government accountability and into line with widely accepted government oversight standards. There are many exceptional things about Chicago, but a lack of protections for oversight in a historically, theatrically corrupt government ought not be one of them. City Council members might be presented with two kinds of arguments against these reforms. The first might be one based in self-interest — an appeal to desires to weaken the oversight to which aldermen are themselves subject. I hope we can all be confident that the people who have raised their hands to serve on the City Council have done so in order to serve the interests of their constituents above their own. The second kind of anti-reform argument might be a full-throated defense of the way things have been done before. And about that, I will say this: All of us in city government ought to work every day to make good on the proposition that Chicagoans deserve better than what they have always gotten from their government. Chicagoans deserve a government that is less corrupt and more accountable, and less opaque and more efficient. We cannot continue to do things the same way and expect different outcomes — and the people in power in this city are not entitled to the status quo. I am deeply hopeful that Chicago is, at long last and long overdue, ready for reform.
