Payment & Practice Management  |   January 2013
Will 2013 Be the Year of the Audit?
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Ambulatory Anesthesia / Infectious Disease / Patient Safety / Practice Management / Technology / Equipment / Monitoring / Payment & Practice Management
Payment & Practice Management   |   January 2013
Will 2013 Be the Year of the Audit?
ASA Monitor 01 2013, Vol.77, 38-39.
ASA Monitor 01 2013, Vol.77, 38-39.
New and revised Current Procedural Terminology (CPT®) codes and any changes in the values assigned to services take effect on January 1 of each year. As important as it is to make certain your practice learns and follows any new coding rules, it is just as important to make sure that you are following all existing rules. Efforts to identify and correct improper, abusive or fraudulent coding and billing are increasing in scope and intensity.
The Recovery Audit Program has been in full swing since 2010. Under this program, the Centers for Medicare & Medicaid Services (CMS) contracts with private companies (recovery audit contractors, or RACs) to conduct issue-specific reviews of claims submitted to the Medicare Fee for Service (FFS) Program. It is expanding into Medicaid as well. These reviews can now include both pre- and post-payment audits. The program is intended to identify improper payments that would include both overpayments and underpayments. CMS recently released results of the Medicare FFS RAC reviews conducted from the start of FY 2009 through June 2012. Those results are summarized in Table 1 (next page). As each RAC is paid a percentage of the corrections it generates, this has proven to be a very cost-effective program for CMS.
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