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Audit Contractor Case Study

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Discuss how Relative Audit Contractor Can Impact A Physician Practice? Recovery Audit Contractors can impact a physician practice in several ways which can be both positive and negative depending on various factors, as we about to witness below. The fact that, these contractors are hired by Centers for Medicare & Medicaid Services to audit and recover dollars to put back into the Medicare Trust Fund, these have a huge incentive as they are paid on contingency, and percentage basis. Therefore, one can be sure that these will be aggressive in their audits. That is; any overpayments found by RACs will need to be reimbursed to Medicare, which can collect their reimbursement from any future claims checks owed to you. RAC audits will be able to …show more content…

Therefore, under this program, RACS were able to recover 95% of the claims they audited. With these RACs in place, would be a great impact on a physician practice for them to become even more careful when billing Medicare claims. Auditing a physician practice in advance can help identify improper billing and coding and take necessary corrective actions prior to the RAC audit. In doing this, helps the practice save time and money, as well as find areas they are being under reimbursed, such that, they can collect their amount when time is still …show more content…

For instance, they continue to report that, the demonstration project found that RAC audits resulted in sizeable amounts of overpayments collected from many providers. That is; they further notice that, data obtained from CMS show that RAC overpayments collected for FY 2010 were $75.4 million, increased to $797.4 million in FY 2011, and increased to $986.2 million in the first six months of FY 2012. According to the American Hospital Association RACTrac audit survey, notes that, the vast majority of these collections represent complex denials where hospitals are required to provide medical record documents in support of their billed claims. It still notes that, this study found out that, the RAC audit program collections are increasing significantly over time and as a result, these collections are having a significant negative impact on the profitability of U.S. hospitals, which in return can negatively impact a physician

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300 Words | 2 Pages

I’ve got some feedback on Barron’s draft: 36-521.02.B – This subsection says we can hold the patient while the screening agency (SA) reviews the application, which is good. However, we want to hold the patient while we make the application to the SA, too. We’d be fine with a timeframe for the hospital to make the application. 36-521.02.D – We have two comments here. 1) As drafted, the subsection says that if a Certificate of Hold is issued by the SA then a hospital can hold a patient for 9 hours, once medically cleared, while waiting for transport to the SA.

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274 Words | 2 Pages

The Patient Protection and Affordable Care Act (ACA) approved the use of Accountable Care Organizations (ACOs) to provide protection, value of care and reduce health care costs in Medicare. The ACO program is a charitable program which began on January 1, 2012. An ACO represents a group of providers and suppliers of services such as hospitals, physicians, and those involved in patient care. These individuals have agreed to work together to coordinate care for the patients they serve under the original Medicare. The objective of an ACO is to provide continuous, high quality care for Medicare beneficiaries, simultaneously improve quality and lower costs.

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360 Words | 2 Pages

Shi and Singh (2015) states that the MedPac was established by the Balanced Budget Act of 1977 as an independent federal agency to advise the US congress on different issues that affect the Medicare program. MedPac regulations consist of analyzing payments to private health care providers that participates in Medicare, access to care, and quality of care (p. 214). Article written by Jill Wechsler (20090 states that MedPac concluded that Medicare payment system should reward value instead of volume to help encourage coordination of care with the different providers as well as constrain cost growth. They proposed alternatives that could help improve physician’s practices by support for graduate medical education, improve chronic care and

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434 Words | 2 Pages

direct costs to hospital, EMTALA enacts direct costs to hospitals for violation of the statute besides the uncompensated care costs to EDs resulted from EMTALA being an unfunded mandate. From the year EMTALA enacted through 2011, hospital lost $573.5 billion from uncompensated medical care cost this resulted in closure of many EDs

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491 Words | 2 Pages

The law seeks to prevent overutilization, preserve freedom of choice, limit cost and maintain competition. Applies to: This law is not applicable for all referrals. The law only applies to Federal Healthcare Programs. E.g. Medicare, Medicaid.

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453 Words | 2 Pages

This may in the long run cut out unnecessary cost for the patients and lead to a diagnosis at an earlier time. With a patient having routine visits to their PCP this allows for a relationship to be built between provider and patient. Having trust in your provider is often an important quality when receiving care. Having a PCP, or gatekeeper, would allow them to follow up with health care maintenance and ensure patient compliance is followed. Especially in the world we live in currently, many health care words such as “Obama Care” and “Affordable care act” can be overwhelming and confusing for any patient.

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479 Words | 2 Pages

The auditing team will need to have a diverse set of skills and experience in order to properly audit Chesapeake Energy. First, the audit team must have experience within the gas and oil industry in addition to understanding the various complications of oil and gas production. Relevant skills and experience include knowledge about the industry, and include work experience related to oil and gas companies. This is critical because many oil and gas companies operate internally and follow IFRS. Some only follow GAAP such as Chesapeake Energy.

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752 Words | 4 Pages

This report recommended actions an individual can take if they made a mistake in the claims process that results in an overpayment by Medicare. Because the claim filing and payment processes are both a human-involved processes, occasional mistakes are inevitable. However, the steps taken once those mistakes are identified are integral to avoiding penalties and violations of Medicare fraud and abuse.

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575 Words | 3 Pages

(September 30, 2013) - The Department of Health and Human Services (HHS) published amended rules applicable to the Health Insurance Portability and Accountability Act (HIPAA) of 1996 in January 2013. As explained by the Secretary of HHS, healthcare has experienced significant changes since HIPAA was enacted in 1996. The implementation of electronic medical records is just one of those changes. The new HIPAA regulations are designed to provide patients with better privacy protection, and additional rights not included in the original HIPAA rules.

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862 Words | 4 Pages

Moreover, the act, in relevance to various Health and Human Services initiatives, such as the Blue Button, will encourage third parties to provide various add-on services, including secure storage of data solutions for personalized health records, APIs and platforms of health that facilitate personalized, mobile devices. Such mandates will probably stimulate innovation in bio-informatics and biometric as regulators aspire to cut Medicare costs via bundled payments and motivate protocolization by providers of care. Protocolization refers to the adoption of evidence-based, standardized and accepted treatment protocols. It is an inherent concept in the ACA and connected incentives for Accountable and Care Organizations (ACOs) and incentivized reimbursement plans in the post-ACA Medicare setting. The consequences of protocolization are reduced discretion for payers, patients and physicians in selecting treatment alternatives, but with increased control over outcomes of treatment and experience of cost.

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415 Words | 2 Pages

Within the security industry it is sometimes necessary to employ an external security contractor. Before we do this we must have an application process in place and have certain criteria for selection. Along with meeting certain criteria the guarding contractor must meet with the required standards and documentation. Firstly, the security staff will often be the first person the public meets, so setting the right image is very important. Being smart and courteous is a must for all security professionals.

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186 Words | 1 Pages

I think it’s wrong for the government to penalize physicians for not meeting compliance standards. However, It’s a great opportunity for the government to aim at small practices because this is where physicians are self-employed. These types of physicians have numerous clinic or health care facilities and are most likely to commit fraud. This seems kind of biased, but it’s true. According to, Ornstein, the most common sanctions are against physicians who have odd Medicare billing reputations (2014, title).

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833 Words | 4 Pages

Physician Coburn noted that poor Veterans Affairs’ budget management led to many deaths as well. He also stated that the Veterans Affairs used roughly $20 billion for non-health-related purposes. Starting in 2001, the Veterans Affairs has paid around $845 million for malpractice cases (Devine, 2014). Rajiv Chandrasekaren noted in an article that nearly 60% of patients claim that the Veteran Affairs is providing poor or barely fair medical care to wounded war veterans. About 50% claim that the Veteran Affairs is offering poor effort when it comes to helping them adjust psychologically to a life outside war (The Washington Post,

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275 Words | 2 Pages

Coe, Rodney M., and Jack Sigler. “Physicians ' Perceptions of the Impact of Medicare.” Medical Care, vol. 8, no. 1, 1970, pp. 26–34. JSTOR, www.jstor.org/stable/3762579. Cohen, Wilbur J. “The First 100 Days of Medicare.”

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1286 Words | 6 Pages

Task 4(c) Construction management (CM) has been out of favour in recent years with only a select group of commercial clients continuing to adopt the route. With the Fraser enquiry into the Scottish Parliament delays and high-profile court cases highlighting the risks of CM, it is not surprising that use of this form of procurement has fallen. However, as the continuing Wembley Stadium saga illustrates, no procurement route, even with as low a client risk-profile as design-and-build, can guarantee a successful outcome. CM’s reputation has shifted from its high point in the 1980s, when it was almost exclusively associated with well-managed and well-resourced commercial projects such as Broadgate and Canary Wharf.

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