contingency fee awarded from that par- ticular audit to CMS.
The American Academy of Profes- sional Coders (AAPC) warns that sim- ply requesting an appeal doesn’t mean physicians don’t have to pay the alleged overpayments within the stipulated time. Overpayments must be returned to CMS before exhausting the appeal process. More information on the RAC appeal
process and timeline is available from the CMS publication MLN Matters, www
.cms.gov/MLNMattersArticles/down loads/MM6183.pdf. When responding to a RAC audit,
AAPC says, a practice should make note of the deadline for submitting records and ask for an extension if it cannot respond by the date specified. Send re- cords back to the auditor promptly. You have only 30 calendar days to respond. AAPC has these tips for physicians who are the subject of a RAC audit:
• Send in as much documentation as you have, but keep photocopies.
• Never alter any charts or records you submit.
• Try to figure out the auditor’s con- cerns.
• To accompany the files, also send a cover letter that includes a descrip- tion of your practice, your practitio- ners, and their credentials, as well as information about the patient’s condi- tion, procedures, and ongoing care.
• Send all documents by certified mail, receipt required.
In addition, TMA advises physicians to call Connolly Healthcare at (866) 360-2507 to verify it has received the records. Physicians also may call the number to address simple errors, such as forgetting to send in a page of the medi- cal records.
RACs rake in overpayments During a three-year RAC demonstration project in Florida, California, New York, Arizona, South Carolina, and Massachu- setts, according to CMS, the RACs suc- ceeded in correcting more than $1.03 billion of improper Medicare payments. But they collected far more money in overpayments than they repaid. Accord-
ing to September 2008 project data from CMS, overpayments recouped totaled $992.7 million, while underpayments amounted to just $37.8 million. The financial implications of overpay-
ment recoupment can be significant for a medical practice. For example, if a RAC finds the average overpayment of audit- ed claims amounts to $25 per claim for 10,000 Medicare patient visits, the prac- tice would owe $250,000 plus interest. The majority of payment errors were due to medically unnecessary proce- dures (40 percent), followed by incorrect coding (35 percent), other errors (17 percent), and no or insufficient docu- mentation (8 percent). The RACs look for outliers, or prac- titioners whose billings for Medicare services are higher or lower than the majority of their peers in the community. Outliers come to the attention of RACs through data mining. Before conducting an audit, Medicare may notify outliers in writing. AAPC says those physicians should review their coding practices to ensure they’ll with- stand an audit. In January, RACmonitor, in associa- tion with The Frank Cohen Group, LLC, surveyed health professionals on the cost effectiveness of the RAC process and to examine the success of physician appeals.
RACmonitor.com is a source of news and information on RAC activities for health care professionals. The organizations hoped respondents’
answers would provide a snapshot of whether the RACs use statistical tech- niques in audits, what overpayment de- mands look like, how often physicians appeal RAC results, and whether physi- cian appeals are generally successful. Of the 316 health professionals who completed the survey, 100 had endured a RAC audit. Eighty percent of respon- dents were medical practices, and re- spondents represented 46 states, in- cluding Texas. Seventy-four percent of respondents indicated the audit resulted in an overpayment demand by the RAC. Survey results brought to light some good news: About 65 percent of respon- dents appealed the RAC decision, and of the appealed records, one-third resulted in a reversal in favor of the practice.
Physician Practice Opportunities
We have exciting opportunities for board certified/board eligible physicians to join Covenant Medical Group. The ideal candidate should have experience and a Texas license.
Emergency Medicine - Lubbock, TX Endocrinologist - Lubbock, TX ENT - Plainvie, TX
Family Medicine With Ob/Gyn - Littlefield, TX Family Practice - Denver City, TX General Surgeon - Lamesa, TX General Surgeon - Plainview, TX General Surgeon - Snyder, TX Hospitalist - Lubbock, TX Internal Medicine - Plainview, TX Pediatric Neurologist - Lubbock, TX Cardiologist - Plainview, TX OB/GYN - Plainview, TX Oncologist - Plainview, TX Orthopedic Surgeon - Plainview, TX Pediatrician - Plainview, TX Pediatric Orthopedic Surgeon - Lubbock, TX
Covenant Medical Group (CMG) is affiliated with Covenant Health System in Lubbock, Texas. CMG is a multi-specialty group with more than 150 physicians across West Texas and Eastern New Mexico. We offer a competitive salary and excellent benefit package. CV should include salary requirements and can be forwarded to Covenant Medical Group, Attn: Kelly Fortney, 3420 22nd Place, Lubbock, TX 79410 or faxed to (806) 723-7476. For telephone inquiries, call (806) 725-7875. E-mail:
kfortney@covhs.org
September 2011 TEXAS MEDICINE 27
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