Due to new healthcare legislation designed to catch overpayments, Medicare recently ‘hired’ several different organizations to begin auditing Medicare claims. There are a number of items of which you should be aware as they can impact – in a very negative fashion – your practice.
These organizations, generically called Recover Audit Contractors (RACs) are paid – and only paid by – a percentage of what they find! This means they are motivated financially to find problems and recoup money from you. Here’s what they are allowed to do…
A. They can request records/bills of up to 10 claims per NPI number (please keep in mind that any incorporated practice has at least two NPI numbers – one for the facility and one for the physician) every 45 days.
B. They can go back to October 1, 2007 in their search.
C. You have 45 days in which to respond to their request.
D. They will then do a chart-to-bill and bill-to-chart audit of those 10 (or 20) records
E. If they find something – and they only get paid if they find something – you can appeal the decision (and normally should).
F. If they show claims were paid in error, you have to either remit payment to them for the amount or they will deduct the monies beginning on day 41 from your current Medicare payments.
We highly recommend that you begin to audit your charts now before the RAC does it for you! We also recommend that someone else besides your normal biller conducts the audit. If you use a billing company, ask if they have the expertise to perform a bill-to-chart/chart-to-bill audit. Also ask if someone else besides the normal biller for your account will be performing the audit. If you use an in-house biller, we strongly recommend that you use an outside agency to conduct your review. It is simply too easy to assume what you have done is correct (sort of like proofing your own writing).
I will be sending out more information on some common billing/coding errors in regards to phlebology practices in the very near future. Do feel free to call or email with any questions about the above.
If a RAC audit team contacts you, you should also engage a company that specializes in assisting practices through a RAC audit. I am working with one right now and happy to give you their name/telephone number if you end up needing some support.
Blatant Advertisement – As I noted above, you should engage someone to do a chart-to-bill/bill-to-chart audit. American Physician has the expertise to provide these services to you. We have a certified coder, access to physician and sonography input if needed, and years of phlebology billing experience. For the sum of $450 we will perform the chart-to-bill/bill-to-chart audit, provide a written report, and telephonically review the report with you regarding any recommendations. If you are an existing billing client of APFS, the audit is free and we will ensure it is conducted by one of our team members who does NOT routinely perform your billing services. Please contact me at 719.233.0099 if you have questions or wish to schedule an appointment.
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