Health Information Management

MAC prepayment reviews hit hospitals hard

HIM-HIPAA Insider, June 19, 2012

Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

MACs have already begun prepayment reviews at hospitals nationwide, and Medicare Recovery Auditors aren't far behind.

MAC prepayment reviews denote a stark contrast from CMS' previous pay-and-chase methodology, says Monica Lenahan, CCS, coding education and compliance manager at Centura Health in Englewood, Colo. "It's a whole new ball game for us," she says.

TrailBlazer Health Enterprises, LLC (TrailBlazer), began auditing the 13-hospital health system in October 2011. The MAC issued 300 records requests systemwide in the first month alone, and that volume has continued to grow, says Lenahan.

Other hospitals are experiencing similar headaches.

"We're getting hit hard by [MAC prepayment audits] at this time," says Paul Belton, RHIA, MHA, MBA, JD, LLM, vice president of corporate compliance at Sharp HealthCare, an integrated seven-hospital healthcare system in southern California. Since Palmetto GBA began requesting records in October 2011, the MAC has audited several hundred records throughout the system, he says. "For the first time ever, this is impacting our cash flow," says Belton.

Click here to read more in the June issue of Briefings on Coding Compliance Strategies.



Want to receive articles like this one in your inbox? Subscribe to HIM-HIPAA Insider!

Most Popular