The,Medicare,Audit,Coming,Your health The Medicare Audit Is Coming To Your Practice: How To Surviv
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So you got the notice...the Medicare RAC is reviewing your practice.Not worried? Think again. The CMS audit of all beneficiaries ofMedicare payments (anyone who files medical claims with Medicare) ishere to stay and if your practice is out of compliance, it could end upcosting you thousands of dollars. It's not all gloom and doom, however.Follow these few simple steps to help get your practice prepared.A quick history of the Medicare RACs. In 2005 Congress authorized theRecovery Audit Contractor (RAC) program to do a demonstration inCalifornia, New York, Florida. The purpose - to discover areas of fraudand waste and recover overpayments made by Medicare due to impropercoding and compliance with Medicare guidelines. The result - over $900million in overpayments recovered and returned to the Medicare TrustFund. Due to the success, Congress authorized the RAC program to berolled out to all 50 states and Puerto Rico no later than January 1,2010.Don't count on it being temporary...this program is to be permanently in place.Anyone who files claims with Medicare - doctors, hospitals, home healthagencies and durable medical equipment providers are all affected. Whatdoes this all mean to you? If you belong to one of the above groups, beprepared to get a notice soon from the contractor in charge of theaudit in your region. The RACs are compensated on a contingency basisbased on the amount of dollars they recoup. You think they are going tobe aggressive? You betcha! The penalties for being out of compliance?At the very least, overpayments will have to be returned. And Medicareisn't going to send you an invoice and wait for the money...they willtake a portion of your current and future claims payments until theoverpayment is paid in full. In extreme cases, Medicare may suspend apractice's claims privileges all together.Here's how to make sure you are covered.First, you may want to conduct an internal assessment of submittedclaims to make sure they follow Medicare guidelines. Either you, yourstaff, or a third-party auditor can do this. However, a certifiedthird-party auditor may be the best option as this allows for someonewith an unbiased look to give you a second opinion. If you do choose todo it yourself, look for claims that have been denied in the past andreview the CMS RAC website.Think about having a certified coder take a look at a sample of yourfiles and help you pinpoint any pattern of inconsistent or errors incoding. Again, a third-party audit service is an excellent option. Aqualified auditor should have certified coders on staff, preferablywith 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 RACthat are not in your favor.Lastly, implement corrective measures to ensure compliance with CMSguidelines before the RAC visit to your practice. The sooner you dothis, the less money you will cost yourself when the RAC visits you. Ifyou choose to use a third-party auditor to help you, they shouldprovide you with a report on areas for improvement as well as consultwith you on other areas of compliance as well.With the right preparation and implementation of processes, you don'thave to fear the RAC. Besides, you may get some good out of your audit.During the same demonstration in the above mentioned states, $38million in underpayments to providers was made. You may find areaswhere you have been underpayed, so there are positive opportunities aswell. Article Tags: Third-party Auditor
The,Medicare,Audit,Coming,Your