by Winston on August 11, 2010
in RAC News
On July 28, 2010, a U.S. District Court in the Southern District of California rendered a decision of monumental significance to all providers who may consider challenging a RAC Contractor for violating the law. The original lawsuit, filed by Palomar Medical Center on March 24, 2009, was the first lawsuit filed against a RAC. The regulation is not complicated on this issue. (Pss … Judge Benitez – Your Honor – didn’t you check out the CMS website? No? You never heard of it? Umm … Sir, that would be the “official government website” that spells out the regulations all providers have to live by.)
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The annual conference of the American Association of Medical Society Executives (AAMSE) was held this year in Seattle, Washington July 21-24th. The nearly 300 attending executives represented medical societies with memberships of a few hundred to several thousand physicians each. Needless to say, these were some very sharp professional people with their fingers on the pulse of physician concerns. . . . [one of the concerns] was that the “highly sophisticated data mining technology” mentioned by President Obama earlier this year was no idle threat. The belief was that probably most physicians either don’t know about it or underestimate just how effective it is. Hospitals are finding out. Physicians are about to.
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More and more physicians are looking for ways to maximize their earnings and protect themselves from future recoupments. In this world of RAC Audits, MIC Audits, ZPIC, the OIG, and continual tightening of compliance requirements, wouldn’t it be great to know that at least your claims are being coded correctly and won’t trigger an audit? If you have thought of outsourcing your coding as just another expense, think again. It’s a proven fact that certified coders pay for themselves several times over by maximizing claim reimbursements while minimizing claim rejections.
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