There have been issues with how the auditing contractors have handled the scenario and Florida and California were able to make some change in tactics with the contractors as they were becoming more of bounty hunters. One physician was billed thousands in overcharges and anticipates winning all except $250.00. But how complicated does the appeals process get? This is another issue where it is less expensive to pay $100.00 or so than to appeal. It sounds like pay for performance for the auditors and they have no regulation. This along with the looming pay cuts is enough to push more over the edge and potentially close up shop. The administrative time involved in researching patient records and sending them, along with the billing records is a monster, when small practices are already under the gun. Instead of auditing after the fact, I would suggest that some of the accuracy should fall back on Medicare to pay claims correctly from the start and not even worry about those under $200.00. This takes time away from time spent with patients to research and resolve. BD
In another payment issue the AMA also discussed payment of on call coverage, whereby 75% of the hospitals stated there is inadequate numbers of physicians, why, the questions and amounts of payment don’t add up to the number of sleepless nights. BD
Aggressive tactics, vague charges, interrupted patient care, drained staff resources and administrative headaches. These are some of the problems doctors say they encountered during their experiences with Medicare's newest breed of auditor. The Centers for Medicare & Medicaid Services this spring wrapped up a three-year pilot program in which "recovery audit contractors," or RACs, scoured physician and hospital claims in three states to find overpayments and to recoup those dollars for Medicare. Thrilled by the project's financial success, lawmakers ordered CMS to expand the program to all 50 states by 2010. The agency plans to choose four national contractors to administer the program this summer. A new round of audits could start right away.
Although Dr. Kaufman didn't end up paying a nickel, his fight took countless hours of unpaid work. "This was controlling my life for about three to four months." Over the three-year pilot, the RACs collected less than $13 million from physicians out of the $980 million in total overpayments they found, with the average overpayment per physician being about $100 to $200.