MEDICARE TO INCREASE AUDIT FREQUENCY UNDER RECOVERY AUDIT PROGRAM
Medicare recently announced that it will be increasing the frequency of its audits under the Medicare Recovery Audit Program in the near future. Under the Recovery Audit Program, Medicare contracts with auditors who review the records of health care providers to determine if Medicare was incorrectly billed for services and if so, to determine the amounts of overpayments due back to the Federal Government. In the past three years alone, the Recovery Audit Program has resulted in the return of more than $300,000,000 to the Federal Government. Medicare has indicated that they will begin monitoring 19 states in the near future, s significant increase from the contractors’ current scope which has been in just three states. An additional five states will be added in October.
In order to help reduce the risk of significant repayment obligations to the Federal Government under a Medicare Audit, it is important to establish a Medicare Compliance Program and to periodically verify that the program is in fact being complied with. Although this may not reduce the risk of being audited, it should help to reduce the risk of a significant repayment obligation. Finally, in the event a provider is subject to a Medicare audit it is important to take the steps necessary to prepare an appropriate response and to be familiar with the steps of the audit process.
For additional information on the Medicare Recovery Audit Program, please see http://www.cms.hhs.gov/rac.
Paul J. Welk
412-594-5536
pwelk@tuckerlaw.com
Thanks for the information. Do you have any data on targeted area of these Audits? In your openion, what percentage of audits will be directed to the large providers(Chain operations, High Volume Hospitals etc.). My practice is in he area of Litigation support post Audits of Third Party Payers. I have been working with a local Law firm to provide Post Audit challenges to the Physician Practice audit findings(PR & UR). I am a former HCFA (CMS)FI auditor and your information will assist me in developing preventive programs for the providers. So far my hospital audit experience has indicated that majority of cases fell victim of poor documentation and improper supervision of coding/billing, resulting in failure to meet Medical Necessity test.Looks like agreesive auditing with no recourse to CMS hearings is in coming to haunt caregivers. Ambulance services and ER Admissions are the area of weakness in just about every hospital I audited in the past. Your comments on this will be appreciated. Thanking you.
Sincerely,
Arun K. Potdar
Universal Placement and Management Consultants. LLC.