"No one should participate in claims or billing practices that are abusive or fraudulent. First of all, it's just wrong. Also, let's not forget the punishment that can be imposed by the federal government when an individual or hospital is considered guilty of fraudulent practices. We're talking a range that goes from restitution, to treble fines, to exclusion from participating in the CMS programs, to imprisonment."
Why does Ms. Fotheringill bring up this subject? It's because of the mounting frenzy of RAC preparedness that includes aggressive self-auditing to uncover all potential problem areas.
"When an improperly billed claim is discovered through any auditing means, the matter should be self-disclosed. Pure and simple."
You'll find her article especially useful when considering how much auditing your facility should undertake in preparation for the RACs. Ms. Fotheringill successfully assists hospitals across the country, overturning "hopeless" denials and generating millions of dollars in otherwise lost revenue rehabilitation.
Reduction in Net Revenue
Leo D'Orazio, MBA, FACHE, says one important issue that should not be overlooked is the need to reserve funds for potential RAC take-backs. Properly identifying RAC liability on the books should be recorded as "a reduction in net patient revenue."
In his article this week, Mr. D'Orazio reminds everyone that in today's economy, hospitals around the nation are under an enormous amount of financial pressure. He quotes The Washington Post's recently published a story on how hospitals across the nation, which employ 5 million+ people, are "reporting that donations and investment returns are down, patient visits are flat and profitable diagnostic procedures and elective surgeries are declining as people with inadequate insurance delay care."
If your hospital is entertaining a major renovation or expansion project, then you need to know your potential RAC liability.
Mr. D'Orazio, MBA, FACHE, is the managing director for WithumSmith+Brown where he directs the healthcare consulting practice for the firm.
Linda Fotheringill and Leo D'Orazio will be joined by contributors Sam Donio and Patricia Dear in this week's timely and relevant RACMonitorEnews. To receive your free edition to RACMonitorEnews, register now on the Home page.