VNAA Meets with CMS on Audit Practices and Payment Denials
Tuesday, June 11, 2013
by: VNAA Policy Team

Section: Public Policy and Advocacy

On Monday, June 3, a VNAA delegation met with officials from the Centers for Medicare and Medicaid Services (CMS) in Baltimore, MD to discuss audit practices and payment denials. VNAA met with several key CMS officials in charge of Medical Review, Medicare Administrative Contractors (MAC) and Fiscal Intermediary (FI) management.

Key issues that VNAA discussed are outlined in a recent letter to GAO, which can be viewed by clicking here, and include:

  • Audits Do Not Target Outliers
  • Inaccurate Denials and Lack of Training for Auditors
  • Lack of Communication and Transparency in Audit Process
  • Financial-Administrative Burden and Timing of ADR
  • Claims Re-Opening Difficulty and Timing
  • Request for Information Outside Patient’s Plan of Care
  • Rate of ALJ Overturns for Denials  
  • Challenges for Small and Rural Agencies

The response from CMS officials was encouraging as they were surprised by some of the concerns raised. CMS noted it would communicate with the MACs. 

Tracey Moorhead, VNAA CEO and President, supported VNAA President, Mary DeVeau, (Concord Regional VNA, NH) in leading the meeting. Other participants included:

Maureen Hanlon, Concord Regional VNA, NH
Margaret Franckhauser, Central New Hampshire VNA & Hospice, NH
Ellen Rothberg, VNA HealthCare Inc., CT
Tim Veach, Intermountain Homecare, UT
Jean Anderson, VNS of Newport and Bristol Counties, RI
Mario Danese, VNA of Ohio, OH

Bob Wardwell, VNAA Regulatory Consultant and Kathleen Sheehan, Vice President for Public Policy also participated in this meeting. For further information, please contact Kathleen Sheehan at or 202-384-1456. 
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