Health Law Partners Warn Of Increased Medicare Auditing Activity

Main Category: Medicare / Medicaid / SCHIP
Article Date: 13 Jul 2009 - 2:00 PDT

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The Health Law Partners, P.C. released a HealthCare Notification entitled: What All Health Care Providers and Suppliers Need To Know About the Medicare Recovery Audit Contractor (RAC) Program.

Written by Abby Pendleton, Esq. and Jessica L.Gustafson, Esq., founding partners of The HLP, this article outlines the issues all Medicare providers and suppliers should know about the RAC program.

The Centers for Medicare and Medicaid Services (CMS) Recovery Audit Contractor (RAC) program has been made permanent and is expanding nationwide. In the very near future, the substantive RAC auditing activity is planned to begin in Michigan, New York, California and Florida,among other states.

Pendleton states, "It is without question that physician practices must begin to prepare now for what promises to be an unprecedented time in terms of Medicare, Medicaid and other payor audit scrutiny."

Pendleton and Gustafson suggest that the Medicare RAC program will definitely change the landscape of the health care environment prompting providers to pay careful attention to medical documentation and coding practices. The authors encourage all physicians to take measures to enhance current documentation practices keeping in mind that records could be selected for audit at some point in the future.

However, all is not gloom and doom. According to Gustafson, "Medicare providers and suppliers must be aware that RAC denials and overpayment demands can be successfully appealed through the established Medicare appeals process." Pendleton continues, "Providers should definitely take advantage of the appeals process. We have seen many providers write-off claims that are winnable. For purposes of defending denied claims, having perfect documentation is certainly not the key to prevailing."

Source
The Health Law Partners, P.C.

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