Scientifi c Meeting


Saturday & Sunday November 12-13


Education & Conference Center


Austin, Texas


✔ Gain insight into recent medical advances


✔ View the top selections of clinical and research poster entries


✔ Analyze the newest evidence-based treatment and management of common medical problems facing internists


✔ Network with Texas chapter members


✔ Meet friends and former colleagues


Members and nonmembers are welcome to attend.


Jointly sponsored with Scott & White. For a brochure or registration information, visit www.txacp.org or call the chapter business office at 512.370.1508.


Visit www.txacp.org to register. AT&T Executive


Annual


2011


RACs target Texas physicians


Congress established the Medicare Re- covery Audit Contractor (RAC) program in 2006 to identify improper payments and reduce fraud and abuse. Until re- cently, says Austin attorney Mark Chou- teau, JD, the RAC program concentrated its efforts on hospitals. But now, physi- cians’ offices are receiving audit letters from Connolly Healthcare, www.connol ly.com, the RAC working in Texas. To conduct the audit, RACs requests


patients’ medical records from physi- cians. RACs link the number of records they request from a practice to its na- tional provider identifier (NPI) number. For example, in a practice with two to five physicians, RACs can examine 20 records per billing NPI, per 45-day pe- riod. RACs limit record requests from solo practitioners to 10 records per 45- day period. To view Connolly’s medical record submission requirements, visit www.con nolly.com/healthcare/pages/RecordSub mission.aspx. Now that Connolly has turned its


attention toward Texas physicians, it’s important to know what to do if you re- ceive an audit letter. Here are some pointers from TMA:


• All office staff members who open mail should be aware of the name Connolly Healthcare and familiar with its logo.


• Designate someone on staff to be the contact person with Connolly. If you have multiple practice locations, you could have one person serve as a contact across the board, or you could have separate contacts for each location. Notify the RAC about your designee(s) using Connolly’s Provid- er Contact Form, www.connolly.com/ healthcare/pages/ProviderContactIn formation.aspx.


• If your practice receives a request for medical records from Connolly, be sure the designated person sees the letter and takes action immediately.


26 TEXAS MEDICINE September 2011


• Verify that the issue for which you are being audited is actually one CMS has approved, www.connolly .com/healthcare/pages/ApprovedIs sues.aspx. Connolly must get all au- dit issues approved by the Centers for Medicare & Medicaid Services (CMS) before it can audit for them.


• Make sure the number of records the RAC is requesting is within these CMS-specified limits:


Group Maximum Requests Office Size per 45 Days


50 or more 50 records 25-49 6-24 < 5


40 records 25 records 10 records


Example 1: Group ABC has 65 physi-


cians who billed Medicare fee-for-service last year. The maximum additional docu- mentation requests (ADRs) for the group is 50 every 45 days. Example 2: Group XYZ has six physi-


cians who billed Medicare fee-for-service last year. Four are located at ZIP code 12345, and two are at ZIP code 21345. The maximum ADRs for this group are 10 per site every 45 days.


• Ensure the dates of service of the re- cords are no more than three years old. (The earliest allowed look-back date is Oct. 7, 2007.)


• Submit to www.connolly.com/health care/pages/RecordSubmission.aspx all information needed to support the case, and verify at https://cmspro vider.connollyhealthcare.com that Connolly has received the submitted documentation.


Once Connolly makes its audit deci- sion, you have two choices:


1. If you agree, refund the requested amount of the overpayment.


2. If you disagree, be sure you appeal within the specified timeframe.


Physicians may appeal an overpay-


ment request if they think there is a mis- take in the audit. If the physician wins the appeal, the RACs must return the


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