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Audits
The Department of Justice recently released their recovery of settlements and judgements. A whopping $4.9 BILLION for calendar year 2012! The Recovery Audit Contractors (RAC) alone collection $2.2 BILLION in overpayments. The RAC program set a record recovery for this past quarter of $779.2 MILLON! Only 2.4% of the RAC audits have been appealed despite the fact 43.4% of appeals are in the provider's favor. I'm happy to say that MBSS has won many of the appeals which we have helped our providers with.
Unfortunately, audits are not going away any time soon. With the new "Campaign To Cut Waste", they are expecting more record recoveries to be made. We are also preparing to see more private payer audits. CMS has announced a new partnership with commercial payers to share Medicare and Medicaid claims data and create a combined private/public data repository. Why does that matter? The carriers will now be able to run statistical data to query all of the charges you have submitted to the participating carriers and then analyze whether providers fall outside of the normal services rendered in a time period.
I encourage you to prepare for future audits. MBSS wants to be proactive in assisting our providers. In preparation for audits, I have added additional resource and educational material to our website. I will update this page continually so check back frequently for new material. Below is a guide to the audits we have seen so far this year.
If you are presented with an audit and a refund is requested...APPEAL, APPEAL, APPEAL!
Please feel free to email me with any additional resources or material you think may assist your fellow providers.
Danielle
Danielle Taimuty, MA, CPC, CEMC
CEO
MBSS, Inc.
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