Check Out What
Our Clients Saved!
Online Quote Center
- Individual Physician
- Medical Group
- Medical Spa
- Surgical Center
- Urgent Care Center
- Skilled Nursing Facility
- Home Health Agency
- Hospice Care
- Teleradiology
- Hospital
- HMO Reinsurance
- Accountable Care Organization
Physician Regulatory Insurance/
RAC Audit Insurance
After findings of improper payments, abuse, and fraud, the Centers for Medicare & Medicaid Services (CMS) created a pilot program in California, Florida, Arizona, South Carolina, New York and Massachusetts known as the Recovery Audit Contractors Program. The pilot program found $900 million in overpayments and $38 million in underpayments. With the success of the pilot program, it has since been expanded nationwide and mandated effective by January 1, 2010.
According to the CMS website, the goal of the program is to identify improper payments made on health care services provided to Medicare beneficiaries. "Overpayments can occur when health care providers submit claims that do not meet Medicare's coding or medical necessity policies."
The success of the program is built into the incentives created for the contractors conducting the audits. Contractors get a certain percentage of overpayments found, which means that the deeper these contractors dig, the more likely they are to find overpayments.
According to the 2010 Report to Congress, almost 192 thousand discrepancies were corrected in that year alone. Regardless of the reason, the safe bet is to assume that you will be audited at some point and possibly multiple times.
Are you in compliance?
Whether you are a hospital, physician's office, home health agency, nursing home, or anyone else who files claims with Medicare, you can expect to be audited. The federal government's aggressive audit program has resulted in the collection of more than a billion dollars in fines, settlements, and other payments from healthcare providers.
Recovery Audit Contractors (RAC) are contracted out by the government to find out if there has been either overpayment or underpayment to healthcare providers. Any medical facility that submits claims to a government program, such as Medicaid or Medicare must assume that they will be audited at some point.
How can you protect yourself?
First and foremost, you should have multiple lines of defense against any financial losses that might occur due to an audit. Conducting an audit of your own is a good way to catch any overpayments or underpayments before a government audit occurs. Assigning these responsibilities to an existing employee can help on an ongoing basis.
On a positive note, some good news may result from your audit. Several million dollars in underpayments have been reimbursed to providers.
Even with all preventative measures in place, odds are that you will still be audited. A well formulated insurance plan is your prominent defense. Our experienced professionals can walk you through the process of obtaining RAC Audit Insurance so you can feel safe knowing that when a government audit occurs, you are covered.
Coverages for your organization may include:
- Medicare & Medicaid Audit
- Commercial Payor Audits
- STARK Violations
- HIPPA Compliance
- EMTALA Violations
