The Medicare Recovery Audit Contractor Program A Survival Guide for Healthcare Providers
Auteur : Abbey Duane C.
Medicare fraud is big business, but while only a few profit from intentional malfeasance, the Centers for Medicare and Medicaid Services is now taking a closer look at everyone. The Medicare Recovery Audit Contractor Program, already infamously known as the RAC, swings into full operation in 2010 and every healthcare provider that receives payment under any of the Medicare fee-for-service payment systems will be subject to RAC scrutiny. And scrutinize, they will .
Instead of developing another bureaucracy, the government has turned the job of auditing over to outside firms whose payment will be based exclusively on finder fees for recouping improper payments. There will be little tolerance for poor record keeping or gray areas of coding.
Written by medical billing guru and Lean accounting expert, Duane Abbey, The Medicare Recovery Audit Contractor Program: A Survival Guide for Healthcare Providers explains all that is required to prepare and successfully defend against inappropriate RAC audit recoveries. Using the same succinct style that always makes his writing so accessible, Abbey illustrates his lessons with simple case studies placed in the context of a fictitious community whose population is served by a hospital, clinics, a nursing facility, and other providers all seeking to maintain compliance and profitability.
In discussing RAC guidelines, this resource
Shows how to identify overpayment areas and associated compliance issues
Details a systematic problem-solving process relative to RAC processes
Addresses resource requirements including new personnel, such as RAC specialists
Includes planning models for developing compliance departments
Provides an extensive glossary to make sense of medical billing?s alphabet soup of acronyms
While the book works well as a stand-alone reference
Date de parution : 02-2010
17.8x25.4 cm
Date de parution : 11-2017
17.8x25.4 cm
Thèmes de The Medicare Recovery Audit Contractor Program :
Mots-clés :
Apex Medical Center; Computerized Axial Tomography; Purpose; Structure; and Intent of the RAC Audit Program; Case Study; RAC; OIG; and Medicare Audits; Healthcare Providers; Review of Healthcare Payment and Payment Systems; Fee Schedule Payment Systems; Understanding the RAC Appeals Process; Freestanding Clinic; Meeting the RAC Audit Challenge; SNF Resident; Improper Payments; Medicare Administrative Contractors; Cpt Code; Standard Code Sets; PPSs; Probe Audit; Physician Supervision Requirement; Fee Schedule; Extrapolation Process; Billing Privileges; Extrapolation Cases; Critical Access Hospitals; Retrospective Audits; Medical Necessity; MPFS