Anesthesia Coding Alert

Check whether your practice might come under extra scrutiny.

Here's your latest heads up for auditing: Beginning August 27, 2012, CMS started its Recovery Audit Prepayment Review prepayment audits in 11 states. The information comes from an announcement on the CMS Web site.

According to the announcement, this program "... will allow Medicare Recovery Auditors (RACs) to review claims before they are paid to ensure that the provider complied with all Medicare payment rules." The statement continues, "The RACs will conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments. These reviews will focus on seven states with high populations of fraud- and error-prone providers (FL, CA, MI, TX, NY, LA, IL) and four states with high claims volumes of short inpatient hospital stays (PA, OH, NC, MO) for a total of 11 states. This demonstration will also help lower the error rate by preventing improper payments rather than the traditional 'pay and chase' methods of looking for improper payments after they occur. This demonstration will begin on August 27, 2012."

Plan change: CMS announced the Recovery Audit Prepayment Review demonstration projection in November 2011. It was originally slated to start on Jan. 1, 2012. CMS then delayed it until June 1, and then again to a vague implementation date of "summer of 2012." It appears that the implementation date has officially arrived.

To read more about the reviews, visit https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/CERT/Demonstrations.html