Improper payments may be over or under payments received by Medicare

Under payments occur when the medical record i ndicates that something more complicated was perforrmed.  The RAC Audit can reveal both problems.  The RACs have been retained to uncover inappropriate paymentws made on claims of healthcare services provided to medicare beneficiaries.  

 

96% of the inappropriate payments are overpayments resulting in over 1 Billion collected.  Overpayments occur when providders submit claims that do not meet CMS coding.  Just three RACs are retained to find inappropriate payments, the othwr three look for situations where MediCare should not have paid at all because other insurance was in place covering the service.  

It is imperative that physicians and practice groups contact their medical malpractice Carrier for resources to help them prior to being named in an audit:  Educate staff about coding:  Develop a RAC Compliance plan, Designate a RAC response team and leader (this is where our Mediguard Plus comes through for our physicians):  track and report and analyze audit patterns, corrective plans of action,  Monitor the trends and enforce in region.  You can check on the RAC website to see which issues they are auditing most frequently,  Involve legal counsel early.

Call The Doctors Insurance Agency for assistance with compliance process plans and insurance
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Comments are closed for this post, but if you have spotted an error or have additional info that you think should be in this post, feel free to contact us.
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