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Are you prepared to deal with Medicare's Recovery Audit Contractor program to recover improperly paid claims next year? If not, TMA can help make sure you are.
TMA will begin the Medicare Update 2010 seminar series in Corpus Christi on Oct. 27 and conduct additional seminars throughout the state through Dec. 1. Participants will learn:
- How to get ready for a RAC audit;
- How to navigate Medicare's five levels of appeals;
- What the Office of Inspector General 2010 Work Plan has in store;
- Best practices for Medicare coding and billing; and
- New rules that affect provider enrollment.
TMA will hold an audio conference on the RAC from noon to 1 pm on Nov. 12 as part of its 2009 Risk Management Distance Learning Series. The presentation will examine an audit's repercussions, how to appeal an audit's outcome, and how to make sure your coding and billing processes are in line to help prevent scrutiny in the first place.
The Centers for Medicare & Medicaid Services says the RAC will include:
- Extensive pre- and postpayment review of claims submitted by ordering or referring physicians, suppliers, and home health agencies;
- Validating claims submitted by physicians who order a high number of certain items or services by sending follow-up letters to these physicians;
- Verifying the relationship between physicians who order a large volume of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), or home health visits and the beneficiaries for whom they ordered these services;
- Identifying and visiting high-risk beneficiaries to ensure they are appropriately receiving the items and services for which Medicare is billed;
- More stringent reviews of new DMEPOS suppliers' applications, including background checks to make sure a principal, owner, or managing owner has not been suspended by Medicare; and
- Unannounced site visits to double-check that suppliers and home health agencies are actually in business.
More information about the RAC and its potential impact on Texas was published in the March issue of Texas Medicine.
Action, Oct. 16, 2009
Last Published: 10/15/2009 Print this page
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