Check your practice for vulnerabilities.
If you’ve heard that recovery audit contractors (RACs) identified improper payments totaling over a billion dollars, you heard correctly. But if you heard that CMS was making changes to ensure these issues don’t happen going forward, you may have gotten bad information.
That’s the word from the OIG’s report, Medicare Recovery Audit Contractors and CMS’s Actions to Address Improper Payments, Referrals of Potential Fraud, and Performance, which the agency released last month to report on whether CMS has taken action based on previous RAC audits.
Background: In fiscal years 2010 and 2011, the RACs identified half of all claims that they reviewed as involving improper payments, which totaled $1.3 billion. Although CMS took corrective actions to address most vulnerabilities it found during those years, the agency “did not evaluate the effectiveness of these actions,” the OIG says in its report. “Additionally, CMS did not take action to address the six referrals of potential fraud that it received from RACs,” the report notes.
How this impacts you: The OIG has asked CMS to start closing in on vulnerabilities and taking immediate action on potential fraud. Therefore, if your MAC was sitting on its hands following RAC recommendations, it could be coming down on your coding and billing habits soon, so make sure you are filing claims properly. To help you pinpoint the most common vulnerabilities as well as tips for dealing with RACs, we’ve broken down the RAC findings below:
To read the complete OIG report on RACs, visit http://oig.hhs.gov/oei/reports/oei-04-11-00680.pdf.