CMS Issues New Statement of Work for the RAC Program
SEPTEMBER 2011 - The Centers for Medicare and Medicaid Services (CMS) published a new Statement of Work (SOW) for the Recovery Audit Program which includes several updates and new areas. Some of the highlights include:
The "Recovery Audit Contractor" title has been modified to "Recovery Auditor". The SOW "includes the review of all claim and provider types and a review of claims/providers that have a high propensity for error based on the Comprehensive Error Rate Testing (CERT) program and other CMS analysis." The collaboration between CMS and all other CMS review agencies is strengthened. The semi-automated claims review previously performed by the auditors is now specifically authorized by the SOW.
The SOW is full of details every healthcare provider type should review. If you are a RAC Coordinator, Revenue Cycle or Patient Financial Services Manager, or Appeals Coordinator, then this should be today's reading! We have included useful links for your review.
For information on how CC&A can assist with documentation improvement, coding education, and data mining to identify risk areas, call (845) 943-6470 or email us at info@christinecoxassociates.com
JUNE 2011 - CMS has published, through its MedLearn article, information on when and how to properly bill for Podiatry services. As many services are under scrutiny for medical necessity, RAC, MIC and other auditing agencies are focusing on "low hanging fruit" or easy to identify services for review. One such area is Podiatry services, especially those considered "routine foot care". Carefully screen your claims to make sure ICD-9-CM diagnosis coding meets documented conditions. Check out this CMS billing article for more information.
For information on how CC&A can assist with documentation improvement, coding education, and data mining to identify risk areas, call (845) 943-6470 or email us at info@christinecoxassociates.com
FEBRUARY 2011 - Currently CMS Review Contractors (MAC, RAC, CERT, etc.) are requesting medical records manually from each provider. CMS intends to give providers a new mechanism for submitting medical documentation. CMS calls this new mechanism the Electronic Submission of Medical Documentation (esMD) and information on this demonstration program at https://www.cms.gov/ESMD/ CMS will give a presentation on this option at the 2011 HIMSS conference (2/21-2/24/10 in Orlando, FL). The presentation should be posted to this CMS website sometime after the conference.
You can check out which CMS Review Contractors will accept this electronic medical record submission plus see which vendors are already developing options for their software to submit directly to CMS Review Contractors.
PRIMARY CARE INCENTIVE PROGRAM: HAVE YOU LOOKED UP YOUR ELIGIBILITY YET?
FEBRUARY 2011 - The Primary Care Incentive Program (PCIP) is a Medicare bonus payment for clinicians who meet certain requirements. National Government Services Medicare (New York & Connecticut – Part B)has a lookup tool to seeif a provider is eligible for thePCIP bonus. The incentive payments will be made on a quarterly basis and will equal 10 percent of the amount paid for primary care services under the Medicare Physician Fee Schedule for those services furnished during the bonus payment year.To lookup what bonus payment year your provider(s) in NY and CT willqualify for, you can use the ngsmedicare.com link below. I have included the(national) NPI lookup link in case you do not have immediate access to this information for your provider(s).
For providers in other states, please go to your Medicare Administrative Contractor website, search for PCIP, and there should be an eligibility lookup tool or similar option available to you.
Please note a separate remittance should be issued with this payment so it is important to alert your payment posting staff regarding this item.
