news: Medicare's new "bounty hunters" may not
have your name on their hit list.
Recovery Audit Contractors (RACs)have aroused apprehension
because their payment comes in the form of a proportion
of the funds they recoup from providers. But at an April
28 special Open Door Forum on the RACs, the Centers for
Medicare and Medicaid Services revealed that:
The RACs have chosen to focus on hospital inpatient claims
for now. The
contractors have the discretion to zero in on whatever
area of Medicare they
feel will be most fruitful.
Former CMS Administrator Tom Scully, calling into the
forum, said he expected the RACs to focus on physician
claims because these account for a high proportion of
all Medicare claims. But CMS officials said the contractors
are more interested in hospital claims, and there's no
requirement for them to look at physician claims. "They
are using their experience in public and private sector
to identify where there are common errors."
The RACs will not audit evaluation and management code
levels. But they may look at E/M visits to ascertain whether
they should have been bundled with a surgical procedure,
or whether they were medically necessary.
the RACs won't be looking for fraud and abuse, only incorrect
coding. And they won't be performing pre-payment audits,
only post-payment ones. You shouldn't hear from the RACs
about a claim that the carriers or other contractors have
already examined. In addition the RACs should follow all
Medicare rules, including the National Correct Coding Initiative
and all Medicare appeals procedures.
RACs are operating in New York, Florida and California for
the next three years as a demonstration project. CMS said
that physician claims will be chosen on the basis of where
their carrier is located. In other words, if you practice
in Florida but your carrier is based in Alabama, you're
safe for now.