First announced last November, CMS has officially enacted their pre-payment RAC demonstration program, effective August 27th. These audits will focus first on Part A services; however providers’ claims and documentation may be scrutinized if the services rendered were clinically related to a patient’s short hospital stay, which can delay payments as much as 45 days. The initial trial period for this review is scheduled to last 3 years, until August 26, 2015 and is applicable to 7 fraud and error prone states; FL, CA, MI, TX, NY, LA, and IL; as well as 4 states with high volumes of inpatient stays: PA, OH, NC and MI.
There are 3 key elements of this demonstration project. First, providers will not be audited twice on the same topic by RAC and MAC auditors respectively, as CMS has asked contractors to coordinate review to avoid duplicate efforts. Next, as with other RACs, specified claims documentation is required to be submitted within 30 days of receiving the request. Last, RACs may ask for 50 records per provider during the program, although there is no set minimum.
APS will continue to support our clients through ongoing coding audits and education, to help ensure your money is not at risk. We are prepared to respond quickly to all requests and appeal pre-payment review denials when necessary. Contact your client representative if you have any additional questions about this or other audit programs.
APS has completely fulfilled all of our expectations, both in clinical pathology professional component billing and in all other areas of pathology billing.