Medicare Audits are on the rise and pharmacists have concerns. So many people have been calling asking “why am I getting audited?” “Do I really need to bother feeling out the audit?” “ It is just one payment I will loss so it’s not that big of a deal, right?”
Well let us examine first what exactly a Medicare Audit is. An audit performed by CMS is to “identify improper Medicare payments and fight fraud, waste and abuse in the Medicare program.”
According to CMS the purpose of RAC audits (Recovery Audit Contractors) are to “identify improper payments made on claims of health care services provided to Medicare beneficiaries.”
With CMS performing these RAC audits they have been able to identify:
- $900 million in overpayments (which has been returned to the Medicare Trust Fund between 2005 and 2008)
- Almost $38 million in underpayments, which was then returned to health care providers (this could be you!)
When you get a RAC audit, it is extremely important that you fill out the paper work completely as asked.
Here are some key facts you need to know about RAC audits:
- You have 30 days from the date the letter was written to return the audit back to CMS with the proper documentation
- You only have 1 chance to send in the supporting documents for this audit. So make sure you gather everything they ask for, especially the physician’s clinical/progress notes
- If you don’t return the entire patient package requested in the audit you will:
- Loss that claims reimbursement
- Set yourself up for more RAC audits
- Potentially go to a 100% Pre-Payment Audit (send all required documentation in before Medicare will reimburse)
- If you lose a RAC audit, you can file a Redetermination form with all supporting documentation to be reconsidered for reimbursement
So it is up to you on what you want to do when you recieve a RAC audit. However, in my opion if you don't take auction, you are setting yourself up for unneeded stress.
