Urgent Information for Medicare – Contracted Providers


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If you treat Medicare beneficiaries, you will in all likelihood eventually meet one of Medicare’s Recovery Audit Contractors, otherwise known as RACs. Recovery audit contractors are Medicare third-party contractors engaged for the sole purpose of identifying services provided by doctors that do not meet the many documentation requirements now required by Medicare for reimbursement.

What happens if you are found to be in noncompliance with CMS requirements? If found to be in noncompliance with Medicare’s clinical payment criteria, documentation and billing requirements, CMS can impose civil fines of up to $11,000 per error, impose treble damages, exclude your practice from Medicare/Medicaid and even impose criminal penalties that include fines and imprisonment!

CMS is paying the permanent RACs approximately 10% of every dollar identified and recouped in perceived overpayments. They are looking for errors made by your medical billing and coding staff – often due to incorrect CPT/ICD9 codes given to the staff by a provider or because of lack of documentation in the chart notes created by the provider. These RAC medical collection agencies appear to be here to stay. It has been written that RAC auditors will be building an automated IT infrastructure that allows for ongoing overpayment determinations and denials for individual healthcare providers on a perpetual basis. Most importantly, RAC audits are not one time or intermittent reviews – they are a systematic and concurrent operating process for insuring compliance with Medicare coverage criteria as well as medical billing and coding guidelines.

Managed Care Alternatives, Inc.’s team of certified coders has significant experience with pre-RAC audit chart review that will identify coding and documentation errors that could potentially cost a practice thousands of dollars. As part of this service, we provide a detailed report showing what percentage of claims were under-coded or over-coded by your medical billing and coding staff according to the documentation in the chart notes. We also identify appropriate alternative coding where applicable to assist you as well as your medical billing and coding staff to increase the bottom line income of your practice.

Additionally, – based on the number of charts we review – we show the dollar value lost as a result of under-coding, as well as overpayments paid to the practice as a result of up-coding (which is where the tremendous liability lies for every provider in the event of a RAC audit).  Finally, we make recommendations for documentation enhancements where appropriate to assist you and your medical billing and coding staff in increasing the bottom-line revenue of your business by achieving the highest possible reimbursements.

We are able to offer this service at an extremely competitive rate.  We can also offer both per-chart and package rates.  When you consider what you could lose as far as time, money and the stress you would undoubtedly experience once a RAC auditor comes calling – not to mention the financial gain you could realize from our coding and documentation suggestions – I think you will find this to be a very economical expenditure.

Please call us at (602) 246-0756 for further information.