{"id":849,"date":"2013-03-25T11:32:48","date_gmt":"2013-03-25T11:32:48","guid":{"rendered":"https:\/\/www.billingparadise.com\/blog\/?p=849"},"modified":"2022-06-06T03:09:32","modified_gmt":"2022-06-06T08:09:32","slug":"mind-it-terrorists-medical-coding-violators","status":"publish","type":"post","link":"https:\/\/www.billingparadise.com\/blog\/mind-it-terrorists-medical-coding-violators\/","title":{"rendered":"Mind It!! Terrorists & Medical Coding Violators…."},"content":{"rendered":"

Healthcare Fraud:\u00a0 On the Wanted List<\/b><\/span><\/p>\n

The United States Department of Justice Considers The Following Three The Worst Form of Culprits, not necessarily in that order:<\/p>\n

1.\u00a0\u00a0 Terrorists.<\/p>\n

2.\u00a0 Violent Crime Doers.<\/p>\n

3.\u00a0 Healthcare Fraud Perpetrators !!!!!!<\/p>\n

Now, how and when the medical profession made it to the chart of ignominy is a moot point; but what is certain is that your practice stands a very good chance of hearing from your region\u2019s RAC if the following does not happen in your clinic:<\/span><\/p>\n

1.\u00a0\u00a0 At least a couple of audits for every E&M Code that you use.<\/p>\n

2. \u00a0Doing the above at least two times in a year.<\/p>\n

3. Getting the above rechecked by at least one outsourced certified coding<\/span> consultant<\/span>.<\/p>\n

4.\u00a0 Doing at least 5 audits for more frequently used codes like 99213 and 99214.<\/p>\n

\"Medicare-Family-Practices\"<\/p>\n

(If your practice\u2019s code utilization happens to mirror the green and blue lines beware!!!!)<\/i><\/p>\n

How It All Started And How It\u2019s Going:<\/b><\/span><\/p>\n

a. Despite a 2-year demonstration; the RAC Audit program was officially deemed to be applicable to all states in 2009.<\/p>\n

b.\u00a0 At that time Medicare was registering 1.2 billion claims per year<\/span> or about 10,000 per minute.\u00a0<\/span> These numbers have increased in the past couple of years.<\/p>\n

c. About 96% of scrutinized dollars involved overpayments or in other words physicians needed to return the money to Medicare.<\/p>\n

d. Only 4% involved Medicare paying the physicians some money for underpayment.<\/p>\n

e. Medicare has recently approved audits of Level 4 and Level 5 E&M services; because of a 25-40% increase in the usage of the codes in the past decade.<\/p>\n

f.\u00a0 Medicare has given approval to extrapolate the audit results; that is if 30% of your charts are analyzed, and out of them around 20% are found to violate the guidelines, that 20% verdict is applicable to the remaining 70% of the charts the auditor will not check.<\/p>\n

g.\u00a0 According to a court verdict in Sep 11, 2012, there is no restricted time limit as to when your charts may be pulled and\/or when you will penalized.\u00a0 Yes, you will be living under the shadow of an audit all your life!!!!\u00a0 Also, your old records are not safe from an audit!!!<\/p>\n

WHY CMS WON\u2019T STOP<\/b><\/span><\/p>\n

If these audits had been lean pickings for the CMS, one could have theorized they would have lost interest in the so-called outlaws.\u00a0 But no, the returns have been substantial.\u00a0 Consider the following figures:<\/span><\/p>\n

1.\u00a0 CMS had received $4 billion dollars in 2011 in healthcare fraud cases.<\/p>\n

2.\u00a0\u00a0 That was about $7.2 per every $1 invested or a ROI of 720%!!!<\/p>\n

3.\u00a0 Thus, they have invested a further $350 million to smoke out the violators!!!<\/p>\n

WHAT YOU NEED TO KNOW AND DO<\/span> <\/b><\/p>\n

If all of the above is making you feel like a cat on a hot tin roof; don\u2019t fret, there is light at the end of the tunnel.\u00a0 Just keep in mind the following:<\/span><\/p>\n

1. If you bill Medicare, then you can be certain there will be an RAC Audit, don\u2019t let it take you by surprise.<\/p>\n

2. Don\u2019t bill Medicare until you are absolutely sure every service has been properly documented.<\/p>\n

3.\u00a0 Don\u2019t jump into the frying pan when an RAC audit request arrives.\u00a0 Remember you have 45 days; use it appropriately to set your records straight (if you haven\u2019t already done it, that is).<\/p>\n

4.\u00a0 Don\u2019t let any Tom, Dick, and Harry in your clinic handle this audit request.\u00a0 Ideally it should be given to a dedicated medical coding vendor <\/i>or medical billing vendor<\/i>.<\/p>\n

5.\u00a0 You have the right to appeal RAC audit verdicts, remember that 1\/3rd<\/sup> of these appeals are successful.<\/p>\n

6. \u00a0Or for that matter Medicare denials need<\/span> to be appealed as well.\u00a0 But sadly only 4% of these are ever disputed, even though nearly 60% of these disputes come out favourably for the providers.<\/p>\n

All in All remember that RAC Audits are not Armageddons waiting to happen, but just speed breakers in your clinic\u2019s path, which can be surmounted if you are careful and assimilate the essentials before meeting it head on.<\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Healthcare Fraud:\u00a0 On the Wanted List The United States Department of Justice Considers The Following Three The Worst Form of Culprits, not necessarily in that order: 1.\u00a0\u00a0 Terrorists. 2.\u00a0 Violent Crime Doers. 3.\u00a0 Healthcare Fraud Perpetrators !!!!!! Now, how and when the medical profession made it to the chart of ignominy is a moot point; […]<\/p>\n","protected":false},"author":2,"featured_media":850,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[745],"tags":[],"class_list":["post-849","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-coding"],"_links":{"self":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/849","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/comments?post=849"}],"version-history":[{"count":0,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/posts\/849\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/media\/850"}],"wp:attachment":[{"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/media?parent=849"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/categories?post=849"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.billingparadise.com\/blog\/wp-json\/wp\/v2\/tags?post=849"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}