No more second Demand Letters

“The Centers for Medicare & Medicaid Services (CMS) has made changes to the
Medicare Overpayment Notification Process”

We wouldn’t want anyone to really understand how this process works, would we?

“If an outstanding balance has not been resolved, providers previously received three notification letters regarding Medicare Overpayments, an Initial Demand Letter (1st Letter), a Follow-up-Letter (2nd Letter), and an Intent to Refer Letter (3rd Letter). CMS would send the second demand letter to providers 30 days after the initial notification of an overpayment. Recent review has determined that the majority of providers respond to the initial demand letter and pay the debt”

“Currently recoupment action happens 41 days after the initial letter. The remittance advice which describes this action serves as another notice to providers of the overpayment. Therefore, effective Tuesday, November 1, 2011, the second demand letters are no longer being sent to providers. Provider appeal rights will remain unchanged. If an overpayment is not paid within 90 days of the initial letter,
providers will continue to receive a letter explaining CMS’ intention to refer the debt for collection.”

What this really means is it is another chance for someone in your office to excel.  Now you have fewer notices from the CMS about a RAC issue, which increases the possibility of your office messing up this process.  Help your practice by making it easier to track the RAC process from beginning to end by using the RAC Tracker.

RAC Auditor Profits

When your business revolves around what the government has created…you end up being the tail that is wagged.

HMS Holdings, one of the largest RAC auditing companies profits drop from $9.82 million to $7.04 million dollars.

Let me hear all the docs in unison: boo hoo, we feel so sorry for you!

There are not too many better business models that can be built.

The government has you scour the books, and for every mistake you find, you get a percentage of what is recovered.

This “plummet” in profits is blamed on “…challenges faced by our clients and carriers in adopting several new CMS-mandated claim transaction formats.”  Once again I know there are many docs out there feeling sorry for these guys.

Note that total revenue increased from $82.5 million to $107.3 million!

These guys are just printing money, on the back of physicians.

You better have a defense plan in place when the RACs really start coming after physicians

RAC Recoveries Accelerating, Look Out

Take a look at this summary report from the CMS.
It will open in a new window.

Basically from Oct 2009 to Mar 2011 the RACs have recovered $365.8M.

Of that over half was collected from Jan 2011 to Mar 2011.

Things are speeding up.

There has been, and still is, a learning curve going on at the RACs.

Once they get fully spun up…look out.

It is interesting to see, yet not surprising at all, that both Region C & Region D RAC top issue are identical.

Really, why not?

I would expect each RAC to share their results among each other to ensure each operates as efficiently as possible.

It is not like they are competing for the same “customers”.

What I don’t understand is how the 3 year demonstration period resulted in $1.03B in recoveries while now, about a year-and-a-half into the full blown program, the recovery is not on track to meet the same goal.

Granted, with the acceleration that is occurring, this exponential increase may take the actual recoveries well past the demo program.

Wake up and smell the coffee Docs…this is going to become a huge headache for you.