In 2006, Congress passed The Tax Relief and Health Care Act, which states that Medicare must expand its Recovery Audit Contractor (RAC) program to all 50 states, and that it must be implemented permanently.
RAC’s detect prior improper payments with the hope that action will be taken to ensure these improper payments do not reoccur. The Centers for Medicare and Medicaid Services (CMS) defines improper payment as, “Any payment to the wrong provider for the wrong services or in the wrong amount.”
However, RAC’s are not responsible for future payments. The Centers for Medicare & Medicaid, Medicare Contractors, and Fiscal Intermediaries for that state are responsible for future payments.
The country is divided into four zones, each containing its own centralized RAC. The RAC’s, in order by zones A through D are: Performant Recovery, Inc., CGI Technologies and Solutions, Inc., Connolly Consulting Associates, Inc., and HealthDataInsights, Inc.
Consulting Associates, Inc., and HealthDataInsights, Inc.
These are the actual entities that work with CMS to audit hospital systems and their payments in their respective states.
‘These affect providers; how does this affect me?’
Lucien Roberts from Modern Healthcare writes ”Medicare estimates that more than 10 percent of its expenditures are for fraudulent claims, a whopping $60 billion per year.”
The Affordable Care Act alone “allocated an extra $350 million to combat healthcare fraud.”
Your provider will be audited and more than likely asked to return overpayments. Providers then pass these savings onto you! Please detect my sarcasm.
To offset lost revenue providers are looking for ways to prepare themselves and their practice for these audits.
One such way is with Expeditor Systems.
Most fraud claims are a result of improper coding. Physicians are often hurried, coders are not purposefully entering claims incorrectly, it just happens.
Expeditor improves the time spent with each patient by allowing for instant communication. Instead of going out into the hallway and searching around for staff, have staff instantly come to you with the press of a button.
This improves documentation and thus, the final satisfaction felt by each and every patient knowing the provider listened to their concerns.
Learn how Expeditor Systems saves you time thus improving your documentation with a free consultation. Contact us today