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In case
you didn't think you were bearing enough audit burdens already,
another layer of scrutiny will come down on your head soon.
The
Centers for Medicare and Medicaid Services has issued requests
for proposals (RFPs) from organizations wishing to become
Recovery Audit Contractors. These contractors will audit
claims from physicians and other providers, and turn the
funds they recoup over to Medicare.
Most
of these recovered funds will go back into the program,
but not all. The contractors will receive an undefined percentage
of the amount they recoup. In other words, the more these
new audit contractors recover from physicians, the more
money they make. CMS' program management division will also
keep a percentage of the recovered funds.
The
audit contractors' pilot program will begin in May and last
three years. The program will affect physicians in three
states - New York, Florida and California - according to
a Jan. 12 Medlearn Matters article posted on CMS' Web site
here.
CMS
has always claimed that if a physician pays a consultant
on a contingency basis, a problem may arise because the
consultant will have an incentive to find more underpayments,
notes attorney Diane Signoracci with Bricker & Eckler
in Columbus, OH. "The same kind of analysis would apply
in reverse," she insists. "[The arrangement] creates
an incentive to be less than careful and more quick to find
an overpayment" than if the contractors received a
flat fee.
Upside:
You will be able to appeal any overpayments these contractors
find to your local carrier. And if the contractors find
an underpayment, they'll pass the matter on to your carrier,
which will return the money to you.
Downside:
"This is just further hassle factor, further unfairness
being injected into the system, and more parasites"
preying on providers, fumes Signoracci. "They're adding
nothing to health care delivery in this country, and they're
just taking away dollars." Most of the overpayments
that auditors usually find involve documentation problems
for medically necessary care that the physician actually
provided.
The
new contractors will come on top of the Payment Safeguard
Contractors that already audit physician claims, plus the
Part B carriers' own audit units. "It's just a feeding
frenzy," says Signoracci.
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