Anesthesia Business Consultants President and CEO Tony Mira discussed upcoming changes to CMS' Recovery Audit Program and devised a series of recommendations to prepare for the audit and appeals process, in a recent blog post.
Here's what you should know.
1. Despite controversy surrounding the Recovery Audit Contractor, the program has been immensely successful, recovering $8 billion-plus in improper payments for the federal government.
2. It's possible the RAC could undergo some changes in the coming year. A federal judge in Washington, D.C., ordered the American Hospital Association to submit suggestions on how HHS could better address the backlog of unreviewed denied claims, after the AHA sued HHS over the backlog. HHS currently has 600,000-plus appeals pending with a wait time of approximately three years.
3. AHA developed two recommendations: have HHS shift responsibility for claim audits to quality improvement organizations and have CMS penalize RACs if the majority of denials are overturned on appeal.
4. The American Medical Association also requested several changes to lighten the administrative burden of the RAC program. AMA believes CMS will accept requests for:
- Improved education efforts on avoiding common billing mistakes
- Working with practices to address coding and billing errors
- Possibly replacing financial penalties with corrective action plans
- Refining reviews to use predictive analytics to better identify claims at risk for improper payments
5. As all this is sorted out, ABC recommends anesthesia practices prepare for audits.
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