The Bounty Hunters

Medicare's recovery audit contractor (RAC) program, the "bounty hunter program," is now a permanent entity. As the Medicare program is facing $34 trillion in unfunded liabilities, it is clear that government has promised more in Medicare benefits than taxpayers can afford long-term.
Although physicians currently face a 21 percent cut in Medicare fees in 2010, government is looking to take more money back from physicians via aggressive "bounty hunting" to help slow the financial demise of the Medicare program.
Amazing the insurance companies are taking from the physicians with constant denials and offering new contracts with lower reimbursements rates and yet the physicians are expected to operate financially as usual. The physician has no place to go to cut costs.
Now we have to deal with RAC. Aggressive RAC attacks are anticipated, and physicians will be targeted for substantial repayments in the coming years. Section 306 of the Medicare Prescription Drug Improvement and Modernization Act of 2003 authorized a 3-year RAC demonstration project. The demonstration program began in March 2005 and ended on Mar 27, 2008.
Section 302 of the Tax and Health Care Act of 2006 authorized the creation of a permanent RAC program to be expanded to all states by 2010. All physicians in all states will be vulnerable to RAC attacks under the permanent RAC program. What can practices do to protect themselves?
Make sure you stay compliant with Medicare billing Regulations by reviewing your current billing and compliance policies to ensure you are in line with Medicare Regulations. According to the Centers for Medicare and Medicaid (CMS), a Recovery Audit Contractor may demand repayment of a claim without reviewing your medical records in the following situations:
1. A statute, regulation, or national or local coverage determination rules reimbursement for a service will always be an overpayment.
2. The service is found to be a medically unnecessary service.
3. Your practice fails to respond timely to a demand letter requesting medical records.
There are many various companies for hire to do pre-audits for your practice. However you can perform your own pre-audit within your practice to identify areas of risk that might be a red flag if an automated review is performed on your patient records and billing.
For more information review the Department of Health and Human Services (HHS) Office of the Inspector General (OIG) Work Plan and review the RAC’s website that is covering your geographic region.