Recovery audit contractors and Medicare administrative contractors will coordinate activities in their hunt for overpayments to hospitals, according to a report by the Report on Medicare Compliance.
For example, MACs, which perform prepayment reviews, might identify a problem with a hospital's claims for certain DRGs and then pass the information on to the RAC to perform retrospective reviews. This cooperation would help leverage the funds of MACs, which are on a limited budget and cannot rely on contingency fees, as RACs can.
"We are asking the RACs and MACs to work collaboratively to develop a strategy about who will do what to reduce the error rate given the respective roles they play," said George Mills, director of the Provider Compliance Group in the CMS Office of Financial Management. "I want RACs and MACs to be coordinated with the goal of reducing the overall error rate."
Mr. Mills said the most frequent errors found by MACs and RACs continue involve billing for short hospital stays, defined as four days or less. These claims account for one-quarter of all Medicare fee-for-service errors. Furthermore, one-day stays that aren’t medically necessary have come to make up 11 percent of the entire error rate.
Read the report from the Report on Medicare Compliance on RACs.
Read more coverage of RACs:
- Two RACs Post Audit Issues, But It's All Very Confusing
- RACs Can Request Claims Not on Approved List
- RACs Finding Errors in Drug Dosages
For example, MACs, which perform prepayment reviews, might identify a problem with a hospital's claims for certain DRGs and then pass the information on to the RAC to perform retrospective reviews. This cooperation would help leverage the funds of MACs, which are on a limited budget and cannot rely on contingency fees, as RACs can.
"We are asking the RACs and MACs to work collaboratively to develop a strategy about who will do what to reduce the error rate given the respective roles they play," said George Mills, director of the Provider Compliance Group in the CMS Office of Financial Management. "I want RACs and MACs to be coordinated with the goal of reducing the overall error rate."
Mr. Mills said the most frequent errors found by MACs and RACs continue involve billing for short hospital stays, defined as four days or less. These claims account for one-quarter of all Medicare fee-for-service errors. Furthermore, one-day stays that aren’t medically necessary have come to make up 11 percent of the entire error rate.
Read the report from the Report on Medicare Compliance on RACs.
Read more coverage of RACs:
- Two RACs Post Audit Issues, But It's All Very Confusing
- RACs Can Request Claims Not on Approved List
- RACs Finding Errors in Drug Dosages