Tip From The Trenches

Date Published: October 31 2013

Trick or Treat? After an unfavorable MAC audit, DME providers will be left alone to get their files in order.

An audit by a Medicare Administrative Contractor is neither a trick, or a treat, but a recent transmittal published by the Centers for Medicare and Medicaid Services offers a sweet tip for providers to see the writing on the wall:

Effective November 19, 2013, Medicare Administrative Contractors (MACs) can conduct a prepayment review of 100 percent of the claims submitted by a targeted provider.

CMS PUB 100-08 Medicare Program Integrity, Transmittal 489

As stated in the pronouncement above, the MACs shall initiate targeted provider-specific prepayment review when there is the likelihood of a sustained or high level of improper payments.

What does this mean for DME providers? If you experience an unfavorable audit, you can expect more audits.

If you haven't already joined the hundreds of providers using, start today and be confident going forward that your face-to-face documentation is in compliance. When you receive a favorable MAC audit, you just might be left alone for a while.

This information is brought to you by Tips from the Trenches, in response to FAQs from our customers. For more information, contact us at or call 800-986-9368.

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