Posts Tagged ‘practice management’
Okay, if you haven’t started getting serious about educating yourself about the Recovery Audit Contractor program, it’s about time you should.
RACs are third parties hired by the Centers for Medicare and Medicaid Services to ensure that physicians are being paid correctly for Medicare Part A and B services. They identify all “improper payments,” whether the physician received too much or too little, and in return receive a share of the booty—I mean, spoils—I mean, identified payments. [Don’t mind me, it’s Friday.]
CMS released an update in late April that showed that in its first 18 months, the permanent RAC program had identified a total of $365.8 million in total improper payments—$312.2 million in overpayments and $52.6 million in underpayments. The agency attributed the four big reasons for improper payments to incorrect coding and billing for bundled services.
The three-year demonstration was wildly successful, too, with more than $900 million in overpayments collected from physicians and suppliers from six states (California, Florida, New York, Massachusetts, South Carolina, and Arizona) and less than $38 million in underpayments repaid.
RACs came to Texas in March 2009 and Connolly Healthcare won the contract for our region, Region C.
Bradley Reiner, TAFP’s practice management consultant, recommends that physicians be involved in the billing process, and implement a compliance plan so employees are aware of potential errors and how to fix them before they become big problems.
The compliance plan is detailed in the second part of an article Bradley wrote for Texas Family Physician in fall 2010. “Ready or not, Recovery Audit Contractors are coming” explains how the program works, how to minimize the risk of being audited, and what to do if you are. Bradley wrote another article in the winter 2009 issue, “Are you ready for the RAC?,” that details the demonstration project.
Both of these will help get you thinking about the RACs so you’ll be prepared if they knock on your door (rather, send a letter). TAFP members can also contact Bradley by phone at (512) 858-1570, or by e-mail at email@example.com for a consultation and discounted services.
The take-away message is that you can’t ignore them. As Bradley says, “If they continue to be successful there is no doubt everyone will have a RAC audit sooner or later. In almost every practice a RAC can find some billing, coding, or documentation issue during any given audit … . The rules are too complex and differ from payer to payer.”
“Real Life Practice Transformation,” a blog by TAFP President Melissa Gerdes, M.D., for AAFP’s Family Practice Management journal, gives physicians advice on implementing aspects of the medical home. Gerdes’ practice emerged as a star of the initial TransforMED National Demonstration Project, making her the perfect physician to share her experiences—good and bad—with the larger AAFP community.
The TransforMED model builds on the physician-patient relationship already cultivated in primary care, while adding new technology and approaches to help practices better serve the needs of patients and practices. The basics of the model focus on increasing patients’ access to care and information, becoming more efficient in practice management, enhancing practice-based services, expanding the use of health information technology, providing better care management, improving quality and safety, coordinating care in a more effective way, and supporting practice-based team care.
If it sounds like a lot, it is, and the NDP proved that practices need support from the entire staff and their patients to start implementing some of the recommendations. Reading Gerdes’ posts is a good first step to evaluating what the TransforMED recommendations can do for your practice.