The CMS Inadequate Process

At the end of last month, the US Government Accountability Office (GAO) released a 52 page report detailing what it sees as a failure by the CMS to establish an adequate process to:

address RAC-identified vulnerabilities that led to improper payments, such as paying duplicate claims for the same service.

Additionally the:

CMS has not yet implemented corrective actions for 60 percent of the most significant RAC-identified vulnerabilities that led to improper payments…

Finally:

CMS did not address significant vulnerabilities representing $231 million in overpayments identified by the RACs during the demonstration project. For the RAC national program, CMS developed a process to compile identified vulnerabilities and recommend actions to prevent improper payments. However, this corrective action process lacks certain essential procedures and staff with the authority to ensure that these vulnerabilities are resolved promptly and adequately to prevent further improper payments.

What does this mean to you?

Certainly, it appears the CMS plans to operate “business as usual”.

No fixes to the broken system, only the heavy hand of the RACs to swoop in, make the physicians life miserable by creating more overhead in processes and the ever-constant fear of a RAC knocking on the door and wanting money.

As none of this will get fixed in the foreseeable future, you need to cover back-side by ensuring your staff is properly trained in all aspects of medical coding.

CMS Announces RAC 101 Conference Calls

CMS Announces Series of Nationwide RAC 101 Calls.

See below for information related to calls.

If you can’t make a call, or missed one, sign up for the Big Picture on the right, and we’ll send out replay announcements.

April 28, 2010 1:00pm – 2:30pm EST: Nationwide RAC 101 Call, 1-877-251-0301

May 4, 2010 1:00pm – 2:30pm EST: Nationwide RAC 101 Call for Home Health and Hospice Providers, 1-877-251-0301

May 5, 2010 1:00pm – 2:30pm EST: Nationwide RAC 101 Call for DMEPOS, 1-877-251-0301

May 12, 2010 1:00pm – 2:30pm EST: Nationwide RAC 101 Call for Physicians, 1-877-251-0301

If you can’t make a call, or missed one, sign up for the Big Picture on the right, and we’ll send out replay announcements.