A Deadly Combination

Data Mining software is nothing new – it has been available for years.   Like computers, its capabilities have grown exponentially due to technological advances.

Paying on commission is nothing new either.  It’s a good way to get results – if the commissioned person or company doesn’t produce, they don’t get paid.   The more they produce, the more they get paid.  It’s a fine system.

The Marriage

But when Data Mining and Commissioned Compensation were married to produce the Recovery Audit Contractor program, our Government crossed a huge threshold.

Never before had we seen such a program.   It will prove extremely effective from the standpoint of those wishing to squeeze maximum Medicare recoupment dollars from doctors and hospitals.

Somewhere I read that before RAC, there were already more than thirty entities authorized to conduct audits of medical claims. No wonder many physicians have greeted RAC with a yawn.

The Offspring

But in reality, RAC has opened a Pandora’s Box that will define virtually all recoupment efforts from now on.  Here’s why.  Prior to RAC, audits were done by salaried government employees whose income was not affected by how much they recovered.

Now you have contingency fees (commissions) being paid to private contractors based on how much they collect.  Other payers such as Medicaid and major insurance carriers (Aetna, Blue Cross, United Healthcare, etc.) are following Medicare’s lead.

In fact, Medicaid’s version is close to launch time. Of course it has an acronym – are you kidding?  It’s called MIC (Medicaid Integrity Contractors), and although details are sketchy at the present time, it appears to have less restraints than RAC. It was authorized by the Deficit Reduction Act of 2005, and has already gone through the demonstration phase.

Commissioned Bounty Hunting is here to stay folks. Forget everything you thought you knew about audits – there’s no turning back now. It’s the new wave of the future.  Get used to it.

Defensive Action

The only way to defend yourself as a physician is to get dead serious about compliance.  The first step you should take is click HERE and get started.  The longer you wait, the worse RAC and other future Bounty Hunters are going to hurt you.