|
|||
|
|||
 |
|||
|
|||
The Centers for Medicare & Medicaid Services (CMS) have taken the next steps in the agency's comprehensive efforts to identify improper Medicare payments and fight fraud, waste and abuse in the Medicare program. CMS has awarded contracts to four permanent Recovery Audit Contractors (RACs) designed to guard the Medicare Trust Fund. In the Tax Relief and Health Care Act of 2006, Congress required a permanent and national RAC program to be in place by January 1, 2010. The national RAC program is the outgrowth of a successful demonstration program that used RACs to identify Medicare overpayments and underpayments to health care providers and suppliers in California, Florida, New York, Massachusetts, South Carolina and Arizona . The demonstration resulted in over $900 million in overpayments being returned to the Medicare Trust Fund between 2005 and 2008 and nearly $38 million in underpayments returned to health care providers. RAC Audits began in the northwest in late summer 2009. For more information visit: http://www.cms.hhs.gov/rac/ . How does a Health Care Provider benefit from having Comprehensive Revenue Solutions perform a Baseline Audit? The Baseline Audit will determine the provider's compliance with the rules at the time of the audit. Recognizing their vulnerabilities in non-compliance of the Medicare rules and being able to promptly change the way they perform either the documentation or the way they are coding their services. By identifying non-compliance and proactively establishing a compliance protocol, health care providers can reduce their chances of having to repay Medicare both in overpayments and fines. How do I know if the RAC Audits have come to my state? Information on the RAC and the schedule for the rollout can be found at: http://www.cms.hhs.gov/rac/ . Providers should not wait for RAC Auditors to show up at their office before doing the Baseline Audit. The purpose of the Baseline Audit is to prepare the health care provider for any internal changes to either documentation or coding their team may need to make. CMS will have specific range of dates of service they will be targeting. Our role is to identify areas of non-compliance. What is the incentive for physicians to have this audit done now instead of later in the year or even next year? The purpose of the Baseline Audit is to identify non-compliance of documentation, coding and billing and to give the physician guidance on all corrective actions he/she needs to put into place, before the Medicare RAC Audit. Why have a 3rd party conduct a Baseline Audit - why not wait for Medicare to come knocking - with many physicians to audit, won't it take a long time to reach everyone? Medicare will not provide any guidance to the health care provider outside of giving them written guidelines. Our experience has shown that 95% of the providers won't take the time to review. The Contracted RAC companies are paid on a contingency based fee, so they have every incentive to find incorrectly paid claims which is directly tied to the documentation on the record. By performing a Baseline Audit the provider receives a Third Party Analysis of findings and recommendations and needed corrective action before they are subject to the Medicare Audit. How often should the audit be redone if it is a clean audit? When Medicare comes to perform the audit, how recent does the RAC Baseline Audit have to be? Yearly. We recommend the Baseline Audit be performed annually with Dates of Services (DOS) starting anywhere from August 2008 to Dec 2008 If a health care provider has completed a Baseline Audit, and has a report of the findings, will they still be subject to an additional audit from Medicare? Having a Baseline Audit performed will be instrumental in helping providers prepare for any corrective action that is needed before they are subject to the Medicare audit. This does not prevent the RAC auditor from performing their own government sponsored audit. What material and hardware are required to participate in this program? A fax machine to send medical records to auditors. An email address to receive the auditors report for the provider. For more information contact: Tanya Richards, Reimbursement Specialist 888.698.3999 ext 101 trichards@CompRevenueSolutions.com |
|||
|
