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.
While there were many interests represented, as my colleagues and I interacted with them during breaks, exhibits and over lunch, several topics seemed to grab the most attention. When asked “what do you do”, we would mention various services we offer, and more often than not the most interest seemed to center on document management, our web-based EMR, and the RAC Review (baseline audits).
Closely connected with RAC audits of course is the ZPIC threat. I found that the executives want to educate their physicians regarding the need for strict compliance with Medicare guidelines, thus conserving income and preventing “pattern of abuse” investigations by ZPIC.
Their Sense of Urgency
Regarding RAC Audits, the consensus seemed to be that the time is rapidly approaching when RACs will target physicians, and it may get ugly. This has been our prediction all along, as regular readers will recognize. Really in-the-know physicians are taking the necessary steps – RAC baseline independent audits, remote coding services, office staff and physician coding training, etc.
The government’s July 2010 announcement of arrests and prosecution of physicians in Florida and elsewhere – with more to follow – has everyone’s attention. Several executives I spoke with mentioned that they were not concerned with protecting those involved in deliberate criminal activity. Their concern is that some physicians, whether through carelessness or otherwise, may be setting themselves up for charges of fraud through a “pattern of abuse”.
No Idle Threat
Their concern 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.
We had a number of executives express the desire to have someone come and speak to their membership. Medical societies are beginning to take the RAC threat seriously, and are concerned that their physician members do likewise.
We do these audits nationwide. The average practice scores run about 60% compliant. The lowest score nationwide has been 32%, and the highest so far has been 78%.
If you are reading this article and either know or are a physician who has not had an independent third-party RAC compliance analysis, drop me an e-mail at firstname.lastname@example.org and let’s talk.
Winston Creath is an independent healthcare consultant working in the compliance and revenue cycle management arenas on behalf of physicians and clinics. He serves as President of National Business Solutions of GA, LLC. He can be reached at email@example.com for questions or comments.