March 18, 2009

Beware the Ides of March

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No literary source ever did more to popularize a specific moment in history than the Bard himself, William Shakespeare, with his iconic reference to the "Ides of March" in his timeless play Julius Caesar. As you might recall, Caesar had been forewarned by a soothseer to be vigilant to a perilous incident predicted to fall on the Ides of March. On that day, Caesar encounters the seer and says mockingly, "The Ides of March has come," to which the seer retorts, "Aye, Caesar, but not gone." And, of course, Caesar would be gone by the end of Scene I, Act III.

 

Meanwhile, the Ides of March continues for the next several weeks as the Recovery Audit Contractors make presentations to state hospital associations in a series of educational workshops now underway throughout the U.S.

 

Region C


Tomorrow, Connolly Consultants' Christine A. Castelli, a principal in the firm's healthcare division, will be conducting a full day of education for the South Carolina Hospital Association. The next stop for Ms. Castelli will be Florida, where educational sessions will be held for three days, March 25-27. Although Texas is in Region C, Ms. Castelli said there might be a schedule change from a March date to one in late April or early May. And because the state is so large, she expects to spend the entire week there.


Region D


Among the first of these was held March 10 and 11 last week for the Nevada Hospital Association and March 17 for the Utah Hospital Association. Then, on March 24, from 2 to 4 p.m., education outreach will take place for the Arizona Hospital Association at the Mayo Clinic in Scottsdale, just outside of Phoenix. Conducting workshops in those states in Region D will be HealthDataInsights (HDI).

 

Region A

 

Promising "robust" outreach education, David Yim, vice president of DSC, the RAC with jurisdiction for Region A, said sessions would take place March 30-31 in New York. As reported previously on RACMonitorEnews, there is a blackout in effect for New England due to the transition of Fiscal Intermediaries (FIs) to Medicare Administrative Contractors (A/B MAC). Part A claims, including Part B of A, will not be available for RAC review until August.


Region B


Finally, rounding out a busy schedule for RACs, it should be noted that outreach education is scheduled in Michigan for April 2 that would be the day following another iconic milestone -April Fools Day.

 

Be Prepared


CMS suggests that healthcare providers should consider the following:

 

  • Conducting an internal assessment to ensure that submitted claims meet Medicare rules.


  • Identifying where improper payments have been persistent by reviewing the RACs' Websites and identifying any patterns of denied claims within their own practice or facility.


  • Implementing procedures to promptly respond to RAC requests for medical records.

  • Keeping track of denied claims and correcting these previous errors.

  • Determining what corrective actions need to be taken to ensure compliance with Medicare's requirements and to avoid submitting incorrect claims in the future.

  • Filing an appeal before the 120-day deadline if the provider disagrees with the RAC determination.



The Outcome


In the three-year demonstration RACs corrected more than $1.03 billion of improper Medicare payment. Of that amount, CMS says approximately 96 percent was overpayments collected from providers and 4 percent was underpayments repaid to providers.
For more information on the permanent RAC schedule, go to racbystate.com.

 

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Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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