October 15, 2009

No Coding, No Billing, No RACs: Just Insurance Schemes

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Imagine a state of healthcare in which there's no coding, no billing and, of course, no RACs. In their place, insurance schemes.

 

Roll that thought around in your mind as you monitor the healthcare reform debate simmering in Congress. Better yet, spend some time with RACMonitor next Thursday when the intrepid Cheryl Servais, MPH, RHIA, describes her eyewitness account of healthcare delivery in South Africa.

 

In the United States, reports Servais, "we take for granted the amount of information we have to manage our facilities: data that outlines revenues and expenditures, not just gross, but broken down by service type, DRG, APC, provider or unit, payer type, etc." And those insurance schemes? Let Servais fill you in on a country that's finding its own way through healthcare reform, sans the RACs.

 

Trick or Treat

 

Back in this country, Nancy J. Beckley, MS, MBA, CHC, senses that there's probably a lull going on - a void between now and when the RACs ramp up their national rollout in January. In her article appearing next Thursday, "RACs Trick or Treat - Filling the Void Between Now and the Beginning," Beckley confesses disbelief when she hears a provider on a conference call wanting to get more information on the RAC program she'd just been hearing about.

 

"Is this possible," asks Beckley, "that providers are just now hearing about the RACs? Is there no sense of urgency?"

 

RACs on Drugs

 

If you, too, are looking to fill the "void," Randy Wiitala, BS, MT, (ASCP), and new contributing editor from MedLearn, suggests a good "fill-in the-void" project.

 

In his article next Thursday, "Assessing Pharmacy Exposure to RAC Audits via Payment Reconciliation Audits," Wiitala reports that hospitals are "strongly encouraged" by CMS to report charges for all drugs, biologicals, and radiopharmaceuticals, regardless of whether the items are paid for separately or packaged, and use the correct HCPCS codes for each.

 

Yet, he reports, he and others continually work with providers who have been forced to pay back significant dollars to Medicare because audits identified billing errors. Wiitala will point out how inconsistent management of billing systems causes errors that directly impact final payment. He'll also identify drugs that have been targeted in RAC audits and tell you how to understand your potential risk - all of which is good since Trick or Treat time is just around the corner.

 

You'll find these and other relevant articles at RACMonitor.com - the number one source for RAC news and information.

 

EDITOR'S NOTE: Cheryl Servais recently returned from South Africa, which she visited as a member of a delegation from the Healthcare Financial Management Association (HFMA) under the leadership of President and CEO Richard L. Clarke, DHA, FHFMA. Servais and other healthcare professionals met for 10 days with eight healthcare organizations representing the South African government, payers, providers and related organizations. Her story represents one of many observations made on the journey.

Chuck Buck

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

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