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Submitted by: Jeff Roh
So you got the letter…the Medicare RAC is reviewing your practice. No big deal? Think again. The CMS audit of all recipients of Medicare payments (anyone who files medical claims with Medicare) is here to stay and if your practice is out of compliance, it could end up costing your practice. It is not as bad as it might seem, however. Follow these few simple steps to help get prepared.
A quick history of the Medicare RACs. In 2005 Congress authorized the Recovery Audit Contractor (RAC) program to do a demonstration in 3 states. The reason – to discover areas of fraud and waste and recover overpayments made by Medicare due to improper coding and compliance with Medicare guidelines. The result – over $900 million in overpayments recovered and returned to the Medicare Trust Fund. Due to the success, Congress authorized the RAC program to be rolled out to all 50 states and Puerto Rico no later than January 1, 2010.
Don’t bet on it going away…this program is to be permanently in place.
Any medical provider who files claims with Medicare – physicians, hospitals, home health agencies and DME providers are all affected. So what does it all mean? If you belong to one of the above groups, expect a notice soon from the contractor in charge of the audit in your region. The RACs are compensated on a contingency basis based on the amount of money they recover. You think they are going to be aggressive? Without a doubt! The penalties for overpayments? At the very least, overpayments will have to be returned. And Medicare isn’t going to send you an invoice and wait for the money…they will take a portion of your current and future claims payments until the overpayment is paid in full. In extreme cases, CMS may suspend a practice’s claims privileges all together.
Here is how to protect yourself.
First, you may want to conduct an internal assessment of all of your claims to make sure they follow Medicare policies. Either you, your staff, or a third-party auditor can do this. However, a qualified third-party auditor may be the best option as this allows for someone with an unbiased look to give you a second opinion. If you do choose to do it yourself, look for claims that have been denied in the past and review the CMS RAC website.
Think about having a certified coder take a look at a sample of your files and help you pinpoint any pattern of inconsistent or improper coding. Again, a third-party audit service is an excellent option. A qualified auditor should have certified coders on staff, preferably with government auditing experience as well.
Comply with Medicare’s request for medical records in a timely fashion. Not doing so may cost you the right to appeal any decisions by the RAC that you disagree with.
Finally, implement corrective actions to ensure compliance with Medicare guidelines prior to the RAC visit to your office. The sooner you do this, the less money you will cost yourself when the RAC visits you. If you choose to use a third-party auditor to assist you, they should provide you with a report on areas for improvement as well as consult with you on other areas of compliance as well.
With the right preparation and implementation of processes, you don’t have to fear the RAC. Besides, some good may come out of an audit. During the same demonstration in the above mentioned states, $38 million in underpayments to providers was made. You may find areas where you have been underpayed, so there are positive opportunities as well.
About the Author: Jeff Roh owns a medical billing company, Profast Billing Solutions. He writes on topics of interest to medical providers in regards to medical insurance billing. For more information on how you can preparefor the Medicare RAC audit visit
profastbilling.com
.
Source:
isnare.com
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