Audit Headaches Drive VGM Members to Capitol Hill

For DME suppliers and complex rehab technology providers working with Medicare, audits are more than just a nuisance. They stretch providers' staffing resources, affect cashflow, and ultimately challenge providers' abilities to continually provide timely and efficient service to consumers. Among the most frustrating points is the lack of consistency in audits and claims rejected for seemingly arbitrary reasons.

The VGM Group, in a Jan. 31 memo to members, said that audits from the Centers for Medicare & Medicaid Services (CMS) can be "debilitating," noting that they can "disqualify claims based on technicality, while ignoring medical necessity of patients."

In response, VGM is mobilizing members to share their audit experiences as part of the Office of Medicare Hearings and Appeals Appellant Forum being held in Washington, D.C., on Feb. 12.

On the following day, Feb. 13, VGM members "will hit [Capitol] Hill for meetings with their respective legislative delegation members," according to a VGM bulletin about the event.

John Gallagher, VGM's VP of government relations, said, ""The forum will be loaded with hospital and pharmacy representation. We want to make sure we're there too, to represent DME as an important part of the audit discussions. The recent memo from the Chief [Administrative Law Judge] has created a spotlight on the issue, and we must strike while the iron is hot."

Gallagher is referring to a memo sent late last year by Nancy J. Griswold, chief administrative law judge, that advised stakeholders that the Office of Medicare Hearings and Appeals (OMHA) was backlogged with claims appeals.

"Due to the rapid and overwhelming increase in claim appeals, effective July 15, 2013, OMHA temporarily suspended the assignment of most new requests for an Administrative Law Judge hearing to allow OMHA to adjudicate appeals involving almost 357,000 claims for Medicare services and entitlements already assigned to its 65 Administrative Law Judges," the Griswold memo stated. "This temporary measure was necessitated by a dramatic increase in the number of decisions being appealed to OMHA, the third level of administrative review in the Medicare claim and entitlement appeals process."

Griswold said that in the last three years, the number of OMHA claims jumped 184 percent, while resources to handle the claims "remained relatively constant."

The Feb. 12 OMHA Medicare Appellant Forum is being held "to provide further information to OMHA appellants and providers on a number of initiatives underway and to provide information on measures we can take to make the appeals process work more efficiently."

Further information is available at

VGM, meanwhile, is encouraging members to participate in the event, either in person or by following the event online via VGM's Twitter feed (@VGMGroupInc). To personally participate in the Washington events, e-mail

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at

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