The Medicare Recovery Audit Contractor Program A Survival Guide for Healthcare Providers 1st Edition by Duane Abbey ISBN B00ZY8F90O 978B00ZY8F90O
Original price was: $50.00.$35.00Current price is: $35.00.
The Medicare Recovery Audit Contractor Program A Survival Guide for Healthcare Providers 1st Edition by Duane Abbey – Ebook PDF Instant Download/Delivery: B00ZY8F90O, 978B00ZY8F90O
Full download The Medicare Recovery Audit Contractor Program A Survival Guide for Healthcare Providers 1st edition after payment
Product details:
ISBN 10: B00ZY8F90O
ISBN 13: 978B00ZY8F90O
Author: Duane Abbey
Medicare fraud is big business, but while only a few profit from intentional malfeasance, the Centers for Medicare & Medicaid Services is now taking a closer look at everyone. The Medicare Recovery Audit Contractor Program, already infamously known as the RAC, swings into full operation in 2010 and every healthcare provider that receives payment under any of the Medicare fee-for-service payment systems will be subject to RAC scrutiny. And scrutinize, they willOC .Instead of developing another bureaucracy, the government has turned the job of auditing over to outside firms whose payment will be based exclusively on finder fees for recouping improper payments. There will be little tolerance for poor record keeping or gray areas of coding.Written by medical billing guru and Lean accounting expert, Duane Abbey, The Medicare Recovery Audit Contractor A Survival Guide for Healthcare Providers explains all that is required to prepare and successfully defend against inappropriate RAC audit recoveries. Using the same succinct style that always makes his writing so accessible, Abbey illustrates his lessons with simple case studies placed in the context of a fictitious community whose population is served by a hospital, clinics, a nursing facility, and other providers all seeking to maintain compliance and profitability.In discussing RAC guidelines, this resource OCoShows how to identify overpayment areas and associated compliance issuesDetails a systematic problem-solving process relative to RAC processesAddresses resource requirements including new personnel, such as RAC specialistsIncludes planning models for developing compliance departmentsProvides an extensive glossary to make sense of medical billingOCOs alphabet soup of acronymsWhile the book works well as a stand-alone reference for those seeking advice on RAC audits, readers will also discover that this volume extends the lesson of AbbeyOCOs classic Compliance for Coding, Billing & Reimbursement, Second Edition, making this book a natural companion for those wanting to fully explore the role of compliance and Lean accounting in medical billing.
The Medicare Recovery Audit Contractor Program A Survival Guide for Healthcare Providers 1st Table of contents:
1: Introduction
SYNOPSIS
CONVENTIONS USED THROUGHOUT THE BOOK
2: Purpose, Structure, and Intent of the RAC Audit Program
INTRODUCTION
RAC DEMONSTRATION PROJECT
Selection and Utilization of RACS
cms and the rac operations
payment of the racs
summary and conclusion
3: RAC, OIG, and Medicare Audits
INTRODUCTION
General Categories of Audits
MEDICARE AUDITS
OIG AND DOJ AUDITS
medicare cert program
OIG GUIDANCE: FEDERAL REGISTER
RAC AUDITS
WHAT HAPPENED TO THE UNDERPAYMENTS?
CMS’s Approach for the RACs
SUMMARY AND CONCLUSION
4: Brief Review of Healthcare Payment and Payment Systems
INTRODUCTION
CLAIMS ADJUDICATION REQUIREMENTS
Covered Individual/Covered Services
Proper Orders with Appropriate Diagnostic Justification
Qualified Facility or Practitioner
Appropriate Documentation
Medicare Billing Privileges
Correct Claim, Filed Timely
Medicare Payment Systems4
Medicare Fee Schedules
Medicare Prospective Payment Systems
Medicare Payment System Interfaces
SUMMARY AND CONCLUSION
5: RAC Audit Issues
introduction
underlying compliance areas
Medical Necessity
Payment System Interfaces
Inadequate Guidance
Confusing Guidance
SAMPLE PROBLEM AREAS BY PROVIDER TYPE
Hospitals
Critical Access Hospitals
Physicians and Clinics
Other Healthcare Providers
SUMMARY AND FUTURE ISSUES
6: RAC Processes
INTRODUCTION
PROBLEM IDENTIFICATION, DATA MINING, AND PROBE AUDITS
AUTOMATED REVIEWS
COMPLEX REVIEWS
EXTRAPOLATION
RAT-STATS Example
Note:
Stratified Sampling
Using Extrapolation in Reverse
SUMMARY AND CONCLUSION
7: Understanding the RAC Appeals Process
INTRODUCTION
APPEALS PROCESS
RAC Discussion
Request for Redetermination
Reconsideration
Administrative Law judge
Medicare Appeals Council
Federal District Court
PURSUING THE APPEALS PROCESS
DEVELOPING ORGANIZATIONAL RESOURCES
CASE DEVELOPMENT
Hierarchy of Medicare Guidance
Clarifying Guidance
Ambiguous Guidance
Incorrect Guidance
Requesting Guidance and the Federal Register
Coding/Billing versus Adjudication/Payment
Directives Inherent in the Payment System
Interpretation of Guidance
Other Issues
MMA 2003 Protection Provisions
ADDRESSING EXTRAPOLATION CASES
SUMMARY AND CONCLUSION
8: Meeting the RAC Audit Challenge
INTRODUCTION
REVIEWING AND ASSESSING CURRENT CBR COMPLIANCE PROGRAM
ADAPTING YOUR CBR COMPLIANCE PROGRAM
BUDGETING AND FINANCIAL IMPACTS
INTERNAL RAC PROGRAM TRAINING
SUMMARY AND CONCLUSION
People also search for The Medicare Recovery Audit Contractor Program A Survival Guide for Healthcare Providers 1st:
how has the medicare recovery audit contractor program changed
what year did the medicare recovery audit contractor program began
medicare fee for service recovery audit program
what is a medicare audit
the recovery audit contractors do