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"Within 10 days of starting with them we received our first check from claims they had submitted. They even went back and reworked all the denied claims from our old billing service and were able to collect on claims that were a year old." Read more... or See all Testimonials |
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Medicare RAC Audits have started and will continue on an ongoing basis. Will your practice be ready if Medicare shows up? By now you probably have heard of the Medicare RAC Audits that are being conducted by the Centers for Medicare and Medicaid. In Section 306 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Congress directed the Department of Health and Human Services (DHHS) to conduct a three year demonstration program using Recovery Audit Contractors (RACs) to detect and correct improper payments and return them to the Medicare Trust Fund. RACs succeeded in correcting more than $1.03 Billion of Medicare improper payments. Approximately 96% of these were overpayments collected from providers, while the remaining 4% were underpayments repaid to providers. Due to the success of the three year demonstration, Section 302 of the Tax Relief and Health Care Act of 2006 made the Medicare RAC Audit program permanent and requires CMS to expand the program to all 50 states by no later than 2010. For a map of the 50 state Medicare RAC expansion schedule, Click Here. Health care providers that might be reviewed include hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers and any other provider or supplier that bills Medicare Part A or B. For a comprehensive report on Medicare's findings of the three year demonstration, Click Here. It is now more critical than ever that you review your current billing and compliance policies to ensure that you are compliant with regulations required by the Centers for Medicare and Medicaid Services. To listen to a Medicare RAC Provider Outreach Seminar, Click Here. The Medicare RAC auditors are paid on a contingency basis to identify both over-payments and under-payments. What this means is they are compensated to find errors. You do have the right to appeal their findings, but anyone who has gone through the appeals process with Medicare knows how frustrating that process can be. The Medicare RACs re looking at your coding, chart documentation and determining if the services you provided were medically necessary. If your documentation is incomplete or not in line with Medicare rules and regulations or the services you rendered aren't deemed medically necessary, you could ultimately have to pay back a substantial amount of money, including fines and penalties, which could pose a huge financial risk to your organization. If your documentation is below Medicare compliance standards, RACs will be back every 45 days with requests for more charts and documentation until standards are met. Not only is this a headache for you and your staff, it can be quite costly as well. A third-party baseline audit review by an experienced firm can prepare you for a Medicare RAC Audit and save you thousands – and pay for itself several times over. Just like you may order an x-ray or diagnostic test to see what is really going on with your patient, there are procedures we can perform to ensure that your documentation is compliant and that your practice is audit proof. Even if you have your own internal audit process in place (and it is a good idea to have), an independent third-party review can give you an unbiased opinion of your current documentation procedures and help to immediately identify any compliance issues your organization may have. The sooner you do this, the better. Any documentation or coding errors that result in overpaid claims that are identified and refunded to Medicare in advance of a Medicare RAC Audit could save you thousands of dollars in fines and penalties. In addition, we have found that we can increase some providers reimbursement rate by as much as 30% by identifying areas of "down coding" and educating these providers on proper coding and documentation so that maximum reimbursement can be achieved without the worry of future audit risk. Atlantic Financial Consulting has the experience and the knowledge to help educate and correct compliance errors as well as assist in putting a compliance plan in place. To learn more about our physician education services, Click Here. As part of our third-party compliance audit, we do an assessment of a random selection of your patient charts for all the providers in your organization. Our highly professional and experienced team of coders will then perform an audit on the charts selected to identify any errors related to improper coding, incorrect documentation or lack of medical necessity. Our audit team consists of coders that have certification from the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA). Our audit team also has specialty specific coding experience. Whether your specialty is cardiology, internal medicine, oncology, or rheumatology, your audit will be performed by certified coders who are familiar with the coding and documentation requirements of your specialty. Once the audit passes the first level of review it is then assigned to a second level for quality control. The coders at this level average 10 years of compliance experience and meet our high standards for excellence in review. Not only are the coders who perform the audit highly experienced, but they also have extensive practice in performing audits for government programs. Some of our staff at this level actually worked on one of the RAC teams during the initial RAC three year demonstration and are well versed in what the RACs look for when examining certain specialties. This experience is so valuable and prized that the US Department of Defense has contracted our team to audit their documentation. Once the audit is complete you will be presented with a confidential, comprehensive report detailing the findings along with recommendations to immediately get your organization compliant with the Centers for Medicare and Medicaid. A debriefing will be held with each provider in a one-on-one session with one of our compliance instructors so that any findings can be discussed so that corrective action can be implemented immediately. Further educational webinars with a live instructor are also available for you and your staff if you wish. Courses are available during lunch hours, after hours, evenings and weekends. You will find that our audit team is very experienced with coding and compliance and that we possess the skills and tools necessary to assess your organizations current compliance status and work with you to immediately fix any areas that pose a Medicare audit risk. The value that we bring to your practice will pay for itself with the peace of mind in knowing where your organization stands in terms of compliance in addition to the potential for us to increase your current reimbursement rate by as much as 30%. For more information or to learn how to get started Contact Us. We appreciate the opportunity to diagnose your practice and assist you in your compliance. |
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Atlantic Financial Consulting |
