Beware: CMS is doing more pre-payment audits

by Anne Zieger on October 3, 2010

Medicare auditorsAh, we all love the Recovery Audit Contractors, don’t we?  The RACs, as we love to call them to evoke their torturuous ways, are a terror if you’re found to have overbilled, mistakenly billed or otherwise annoyed Medicare.

As most of us know, the RACs are empowered to demand money back on behalf of CMS. What’s not as well known as that the RACs are also getting more aggressive about “prepayment reviews” as well.

According to an attorney interviewed in Home Care magazine, CMS has simply decided that if it’s going to lower the cost of fraud and error in billing they might as well avoid inaccurate payments up front. What’s more, with the baby boomers aging, demand for durable medical equipment orders is growing, and avoiding misbilled DME can have a big financial impact, notes, healthcare attorney with Brown & Fortunato.

Where DME suppliers are concerned, they face prepayment reviews, a) simply because CMS  has routinely focused on that category of item, or b) because RACs and other auditing groups have found a problem with that particular entity.

In many cases, the unfortunate supplier who get snared in this net will be on prepayment review until its charge denial rate hits or drops below 20 percent, Brown tells the magazine.

I won’t bore non-compliance-oriented readers with the long list of steps involved in responding to such incursions, but suffice it to say that a very, very deliberate approach — and careful CMS communication — are critical to survivial in a situation such as this.  Check out Brown’s remarks and see for yourself.

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