Medicare Compliance & Reimbursement

Communicating with your RAC is key.

How can you prepare for complex RAC reviews? The Centers for Medicare & Medicaid Services (CMS) tells Eli you should take the following steps:

Know Where Previous Improper Payments Have Been Found

• Look to see what issues the Recovery Auditors have previously reviewed. Recovery Auditor websites can be found at: http://tinyurl.com/kwu2xbr.
• Look to see what improper payments have been found in OIG and CERT reports:

                     o  OIG reports: https://oig.hhs.gov/reports-and-publications/index.asp
                     o  CERT reports: www.cms.hhs.gov/cert

Know if You are Submitting Claims With Improper Payments

• Conduct an internal assessment to identify if you are in compliance with Medicare rules.
• Identify corrective actions to promote compliance.
• Appeal when necessary.
• Learn from past experiences

Prepare to Respond to Recovery Auditors Medical Record Requests

• Tell your Recovery Auditor the precise address and contact person they should use when sending Medical Record Request Letters.

                    o  Call your Recovery Auditor.
                    o  Use Recovery Audit Programs’ websites.

• When necessary, check on the status of your medical record (Did the Recovery Auditor receive it?) again. 

                    o  Call your Recovery Auditor.
                    o  Use Recovery Audit Programs’ websites.

Learn From Past Experiences

• Keep track of denied claims.
• Look for patterns.
• Determine what corrective actions you need to take to avoid improper payments.