Medicare/Medicaid
AMA’s Statement to the Practicing Physicians Advisory Council regarding Consultation Services, PECOS, and other issues (December 7, 2009).
Resources for Medicare Audits
Recovery Audit Program (RAC)
Medicare’s Recovery Audit Program (RAC) is a program that will be utilized by the federal government to address waste, fraud, and abuse in the Medicare program. It is designed to identify overpayments and underpayments and was initially rolled out as a demonstration project. It is now permanent and national and is scheduled to begin in New Jersey in August of 2009.
The RAC identified and recouped over $900 million in overpayments between 2005 and 2008. It also identified and refunded over $38 million in underpayments. The program has been controversial in the provider community because the contractors are paid on a contingency fee basis.
Contracts for four recovery audit contractors (RAC) were awarded in October of 2009. New Jersey is in Region A, sometimes called the “blue” region. Regiona A's contractor is Diversified Collection Services (DCS). The RAC begins in New Jersey on August 1, 2009, but CMS is required to provide outreach and education before the program begins. CMS and MSNJ will co-host a telephone conference for MSNJ members on July 14at 11:30 a.m. as part of CMS’s outreach. Registration is required. Read
CMS’s presentation. Read
DCS’s presentation.
Improvements made to the RAC program include limitations on the number of medical record requests as well as a limit on the look- back period to October 1, 2007, then, once the program is implemented not more than a three year look-back. The RAC contractors must employ a physician medical director and a certified professional coder.
It should be noted that the RAC contractors have discretion in creating their own processes for auditing. However, CMS has oversight and reviews their processes for significant issues. AMA has a pending request to CMS to review the processes for consultations and evaluation and management codes.
Members are urged to prepare for the RAC program by conducting internal audits. For practical suggestion, read
“RACS are Coming--Prepare! Prepare! Prepare!" By
Kay Stanley, FACMPE.
Highmark Medicare Services unveiled a new Enrollment Center
Access the Enrollment Center from the home page of Highmark Medicare Services website. For more details see
presentation.
AMA resource: Understanding the Basics of Medicare’s Electronic Prescribing Incentive Program
Do you know the basics of Medicare's e-prescribing incentive program?
With the Centers for Medicare & Medicaid Services' Electronic Prescribing Incentive Program scheduled to begin in January, many physicians are preparing for a transition from paper and faxed prescriptions to a computer-based electronic generation, transmission and filling of a prescription.
To help with inquiries that may arise, the AMA created a
"frequently asked questions" flier (PDF), "Understanding the basics of Medicare's electronic prescribing incentive program." This new guide covers the fundamental basics of the program, including such topics as what the program is, incentive amounts for using the program, eligibility criteria to receive incentive payments and reporting and system requirements.
Download several other resources to aid in the transition, including 2008 Interim Meeting of the AMA House of Delegates presentations entitled
"AMA electronic prescribing incentive program" (PDF) and
"SureScripts-RxHub electronic prescribing overview," (PDF) as well as a
spreadsheet of Medicare-allowed frequency and charges by specialty and provider (PDF) to help further determine the program's potential reimbursements.
Web Sites
Resources:
HIGHMARK
Part B Frequently Asked Questions (FAQs) have been updated: