Please note, HMS will be closed Monday, May 27 in observance of the holiday. Our offices will reopen at 8am on Tuesday, May 28.
The service is among the many payment changes finalized in the annual regulation announcing program rates for the next year. The fee schedule includes an across-the-board sustainable growth rate (SGR) cut to physician pay, a reduction that federal officials calculated at 26.5% and other rate cuts such as lower payments for multiple advanced imaging scans and penalties for failing to submit quality measurements to the Centers for Medicare & Medicaid Services (CMS).
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HMS Healthcare Management Solutions has been diligently working behind the scenes to modernize and update our website. We will be launching Phase I of our new site very soon and look forward to bringing you more enhancements during Phase II of our upgrade.
Stay tuned for more big changes from HMS as we continue to develop our website and product lines for healthcare providers across the continuum.
A recovery audit contractor, or RAC, represents an effort to audit healthcare providers to ensure they are not overbilling. The Centers for Medicare & Medicaid Services (CMS), which oversee the programs, selects recovery audit contractors to perform audits at provider facilities.
The goal of the recovery audit program is to identify improper payments made on claims of health care services provided to Medicare beneficiaries. Health care providers that might be reviewed include hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers and any other provider or supplier that bills Medicare Parts A and B.
Though RAC audits were instituted to protect the Medicare system from fraud, waste and abuse, RAC contractors are compensated on a contingency basis, which means they are only paid when they find overpayments or potential fraud. For this reason, health care providers must have their records and accounting system in order to protect from an audit in which RAC contractors may be extremely aggressive in looking for problems.
Given the aggressive nature of RAC audits, health care providers should consider consultation to best protect their interests. HMS Healthcare Management Solutions can help providers organize their records and prepare for an RAC audit. Contact us today to see how our team of professionals, experienced in all stages of the appeals process, can help.
Section 302 of the Tax Relief and Health Care Act of 2006 made the Recovery Audit Program (RAC) permanent and required the program to extend to all 50 states by 2010. As the audits continue to expand, it’s important for providers to be sure they are in compliance and organized for an audit should one come their way.
To help sort through the confusion, HMS Healthcare Management Solutions is launching a RAC audit blog series. Count on HMS to sift through the who, what, when, where, how and why? to better prepare you for a RAC audit.
Look for Part I of our RAC audit blog series later today and stay tuned to the HMS blog for the latest news, information and trends in healthcare.
Earlier this month, HMS Healthcare Management Solutions President & CEO, Donna Galluzzo, Director of Operations, Robbin Boyatt and Director of Consulting, Cheryl Leslie engaged in a discussion about the Patient Protection & Affordable Care Act (PPACA) as guests on The Hour with Jim Pellegrino.
Though the ICD-10 deadline change has yet to be published, planning for the transition should continue as the switch to the new code set will affect every aspect of how your organization provides care.
An impact assessment of how the new code sets will affect your organization will help you plan for the transition. Below are some guidelines for what you should include in your assessment.
- Documentation Changes: Consider the increased specificity of ICD-10 codes compared to ICD-9 codes and ensure that patient encounters are documented with appropriately comprehensive clinical descriptions.
- Reimbursement Structures: Coordinate with payers on contract negotiations and new policies that reflect the expanded code sets, since they can affect reimbursement schedules.
- Systems and Vendor Contracts: Ensure your vendors can accommodate your ICD-10 needs..
- Business Practices: Determine how the new codes affect your processes for referrals, authorizations/pre-certifications, patient intake, physician orders, and patient encounters once ICD-10 is implemented.
- Testing: Work with your vendors to determine the amount of time needed for testing and schedule accordingly.