Audits

Do you feel helpless against the threat of lawsuits? Many docs do. Yet there are ways to reduce your risk of being sued. Arm yourself with best practices, to keep malpractice lawyers at bay.

There’s good reason for physicians to be worried about Medicare’s new Recovery Audit Contractors, better known as “the RACs.” Like auditors for Medicare carriers, the RACs seek to recover money for the government by finding evidence of overpayments to hospitals and physicians. What makes these four private companies different from traditional auditors is that they’re being paid a percentage-9 to 12 percent-of whatever they recover from providers.

There’s good reason for physicians to be worried about Medicare’s new Recovery Audit Contractors, better known as “the RACs.” Like auditors for Medicare carriers, the RACs seek to recover money for the government by finding evidence of overpayments to hospitals and physicians.

Recovery Audit Contractor (RAC) is a term that every Medicare healthcare professional and staff member needs to know.

Rumors of stricter enforcement of privacy and security rules have been heard before but this time there’s reason to believe that tougher scrutiny is indeed coming.

An internal medicine specialist was fleeced badly by the Mother of all Embezzlers. Don’t think it can’t happen to you until you read what happened to her.

The customer is always right, until he is wrong. In an age of consumerism, how do you say no without losing patients?

Is your IT guy too powerful? In a small office, just one staffer often holds the keys to the kingdom. What if he quits abruptly - or worse, holds you hostage?

Surgical package; billing family members; using 99211 for new patients

Here's how to properly use E&M code 99213, including when other CPT options might be more appropriate with patients at your medical practice.

In light of the expansion of Medicare’s Recovery Audit Contractor program, physicians are taking a second look at their coding practices.

Medicare hopes to save millions with tougher billing rules and aggressive audits - changes that could cost your practice money. But if you bill right and on time, you can keep that Medicare check coming.

I am about to become an employee of a group whose culture is to do “routine annual physicals” (RAP). I had mostly stopped doing physicals for patients with Medicare since physicals are usually not covered (unless by a secondary insurance or Medicare advantage plan).The group I will join usually bills Medicare for RAPs, using the 99215 code, plus an additional charge for (I think) 99397 or some other “preventive” code. Are other practices still using 99215 with Medicare patients? Have there been actions from the OIG to recover overpayments related to the use of 99215 for physicals? Can you offer suggestions that would help me get this clarified? It seems, for example, that an internal audit by someone familiar with Medicare rules would help either reassure me or make it clear that the group is not in compliance with Medicare rules.

See who the RACs are in your region.

Following a two-year demonstration project in four states, Medicare’s Recovery Audit Contractor (RAC) program is going nationwide in 2009.

Coding is no fun, but you gotta get it right if you wanna get paid. Here’s our guide to coding like a pro.