HCPro.com: Health Care Auditing Strategies

May 2008 (Volume 7, Issue 5)	view entire issue

Get ready for RAC audits: Six tips to help you prepare
CMS recently ended the demonstration phase of its recovery audit contractor (RAC) program and began permanent, nationwide implementation. RACs, or independent contractors hired by CMS to ensure proper Medicare payments, are paid contingent upon finding over- and underpayments. If your facility is not in one of the pilot states-New York, Florida, California, South Carolina, and Massachusetts-don't relax yet. It only means you have some preparation time. And that time could make a significant difference to your RAC results, says Lynn Grieves, chief compliance officer at Memorial Care Medical Center in Huntington Beach, CA.

Time to prepare for present-on-admission investigation
CMS completed its phased implementation of the present-on-admission (POA) reporting requirements April 1. That means your POA auditing strategies need to be in place now to ensure proper reimbursement down the road. The POA reporting initiative is part of a CMS program, mandated by the Deficit Reduction Act of 2005, that requires quality reporting aimed at ferreting out hospital-acquired conditions.

Myths and misconceptions to refute about the changing role of compliance officers and auditors
In the past, compliance officers labored to ensure hospital bills were correctly coded. With the financial health of the institution in the balance, there was much at stake. Fast forward to today's compliance officers and you see a plate filled with more than coding and billing concerns. Today's compliance officer must straddle at least three worlds: government regulations, organizational efficiency, and patient protection.

Use internal audits to find Medicaid problems
Today you need to worry about more than Medicare billing errors-Medicaid investigations are on the rise. And its time to take all the cautionary tales you see in newspaper headlines to heart. "Now more than ever, it's important to have an audit component to your compliance program," says Maureen Weaver, an attorney at Wiggin and Dana in New Haven, CT, who participates in internal and government Medicaid audits.

Other recently-published articles from Health Care Auditing Strategies:

Patient status: Five tools to conduct internal audits

OIG attention on DSH payment program escalates

OIG increases oversight for Medicaid mental health

New York’s new work plan offers audit cheat sheet

Patients’ Bill of Rights: How and when to abide by it

Examine FMV for physicians in administrative roles

Three-pronged approach appropriate for quality concerns

EMTALA provides ongoing challenges, opportunities

Use internal audits to find Medicaid problems

Myths and misconceptions to refute about the changing role of compliance officers and auditors

Time to prepare for present-on-admission investigation

Get ready for RAC audits: Six tips to help you prepare

Use these tips and tools to tackle physician audits

Compliance’s new frontier: The quality movement

Protect compliance practices

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