Medicaid claims audits slated for January
|
|
Posted On :
Oct-12-2011
| seen (175) times |
Article Word Count :
721
|
|
The Medicaid recovery Audit program is due to get implemented nationwide in January, carrying on in a similar vein as Medicare RAC program, as announced by CMS on 14th September, 2011. The states will enter into a contract with the Medicaid RACs, which will review the past claims that have already been paid and scrutinize them for fraud, waste and abuse.
|
|
The Medicaid recovery Audit program is due to get implemented nationwide in January, carrying on in a similar vein as Medicare RAC program, as announced by CMS on 14th September, 2011. The Medicare RAC had recovered $451.3 million in overpayments and corrected $78.5 million in underpayment within six months in 2011.
The Dept. of Health and Human Services estimates that Medicaid RACs will save the program $2.1 billion over the next five years, of which $900 million will revert to the states. The states must implement Medicaid RACs by Jan. 1, 2012, according to the final ruling.
The states will enter into a contract with the Medicaid RACs, which will review the past claims that have already been paid and scrutinize them for fraud, waste and abuse. The auditors will be recompensed by getting a percentage of the funds they recover as having been inappropriately paid to doctors, hospitals and others. However, AMA has indicated its discomfort over the fact that RACs will be paid on the basis of their recoveries.
At the same time, the final rule also directs states to pay reviewers for uncovering underpayments that must be reimbursed to those filing the claims.
Browse All: Medical Billing Medical Biller and Coders
The CMS has incorporated certain points in the Medicaid Audit program which were not present in the Medicare Audit program:
Each Medicaid RAC must hire a physician as medical director
The CMS has called upon the states to place a limit on the frequency and age of claims that Medicaid RACs can request from claimants for review
Requiring states to coordinate their Medicaid RAC activities with those of other auditors; RACs cannot audit claims already being investigated by another entity
Requiring RACs to return their fee if an overpayment determination is reversed at any level of appeal
The audit program is likely to aggravate the reimbursement as well as administrative burdens of the providers. Overall a need has been expressed for the CMS to take effective measures to educate providers as well as other health professionals to pre-empt inadvertent coding mistakes and the consequent incurring of penalties. In fact, these issues once again underscore the wisdom in utilizing trained and experienced billing and coding professionals well versed in handling RACs audits to pro-actively avoid auditor scrutiny.
About Medical Billers and Coders
Medical Billers and Coders is the largest consortium of Medical Billers and Coders in the United States. Our aim is to help the physician community to reach the right expertise in the right location at the right time.
Physicians usually prefer the technology and expertise of a large billing company and the customization and attention of a local Biller Medical Billers and Coders brings out the best in both the options and caters to the exact need of the physicians' billing requirement.
From Anchorage in Alaska to Honolulu in Hawaii and from Port Orford, Oregon in the west to Boston, Massachusetts in the east our network is spread across the nation. Healthcare is well spread out and so is our representation. Our Billers will service your office within a radius of 30 miles and be discussing your billing process updates weekly. You can benefit from our consortium by:
Looking up Billers who have been servicing your specialty for years
What connects such a big network is our technology, our web based software through which we can use the best biller for the specific specialty, though doctors comfortable with their technology can continue to do so, or switch to ours and also receive federal stimulus for it.
The benefit of centrally done operations and economies of scale is also passed to physicians/ you in terms of effective pricing.
The expertise of specialty wise billers is directed towards billing claims appropriately and getting maximum revenue for the practice.
Our billers are always updated with the latest in specialty billing regulations, state billing regulations and government regulations. They are always motivated to keep their certifications updated and know more about the industry.
Browse all: Alexandria Medical Billing, Amarillo Medical Billing
|
|
|
|
Article Source :
http://www.articleseen.com/Article_Medicaid claims audits slated for January_91114.aspx
|
|
Author Resource :
Medicalbillersandcoders.com is the largest consortium of Medical Billers and Coders in the United States. We offer Medical Billing, Alexandria Medical Billing, Amarillo Medical Billing
|
|
Keywords :
Medical Billing, Alexandria Medical Billing, Amarillo Medical Billing,
Category :
Business
:
Business
|
|
|
|
