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CMS Transfers Responsibility
By Staff Reporters
January 2012 marks a significant change for Recovery Auditors as the Centers for Medicare & Medicaid Services (CMS) is transferring the responsibility for demand letters from the auditors to claims processing contracts. The reason for the change is “to avoid any delays in demand letter issuance,” according to MLN Matters article 7436.
The Result
As a result, when a Recovery Auditor finds improper payments, they will submit claim adjustments to your Medicare (claims processing) contractor. The contractors will carry the responsibility of fielding concerns throughout the time frame of the payment recovery and the appeals process.
Assessment
Read the full article here.
Conclusion
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Filed under: Breaking News, Health Law & Policy, Practice Management, Risk Management |
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 
Medicare Integrity Program [MIP]
Medicare fraud fighters earned bipartisan accolades as Senators from both parties praised the agency after a new report gave it plaudits for making better use of fraud-fighting dollars.
Click to access d11592.pdf
Kenneth
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Medicare Overpaid Docs $28.8 million according to Auditors
Auditors estimate that Medicare overpaid physicians $28.8 million in 2008 and 2009 for ambulatory and outpatient services that were performed in hospitals instead of doctors’ offices, according to two reports released Friday. But federal officials say they may not investigate because of the cost of reviewing paid claims.
Under Medicare, the entity that provides the space for a medical procedure is compensated for its overhead costs. Physicians, or their independent billing consultants, can increase Medicare reimbursements by claiming to have provided space for the services that were actually done at hospitals or freestanding ambulatory surgery centers. Investigators with HHS’ Office of the Inspector General reported that they found more than one million Medicare claims for which both hospitals and physicians were paid for providing facility space for the same procedure on the same day for the same patients in 2008 and 2009.
Source: Joe Carlson, Modern Physician [9/16/11]
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Medicaid Claims Audits to Begin in January
Physician and hospital organizations praised several changes federal health officials made to an earlier proposed version of a new Medicaid claims audit program authorized by the health system reform law. The Centers for Medicare & Medicaid Services on September 14th released a final rule detailing implementation of the Medicaid Recovery Audit Contractor program, based on a similar Medicare program in operation nationwide. The Medicare RACs have come under fire from physicians for what doctors have termed aggressive auditing tactics, prompting some critics to label them “bounty hunters.”
Some aspects of the Medicaid audit program will mirror the Medicare approach. States will contract with the Medicaid RACs, which will search for fraud, waste, and abuse in the program by reviewing past claims that already have been paid. Auditors will be compensated based on a percentage of funds they recover that were paid inappropriately to doctors, hospitals, and others. The final rule also directs states to pay reviewers for uncovering underpayments that must be reimbursed to those filing the claims.
Source: Doug Trapp, AM News [9/26/11]
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