Why is the government ramping up RAC audits? Health care fraud costs US Taxpayers $60 Billion a year. Federal Agents charged close to 1,500 people last year alone.
Ever wonder why the government is spending more and more money on RAC audits and other fraud detection and deterrence initiatives? Each year it seems the Department of Justice and Office of Inspector General uncover more and more shocking examples of fraud and abuse. In the last year alone the feds have arrested con artists who steal Medicare numbers from the elderly in order to submit false claims, doctors that prescribe excessive amounts of controlled substances so they can sell them on the streets, even some who steal federal grant money intended for cancer or autism research. Not only are these acts deplorable and morally reprehensible because they steal money that is intended for the disadvantaged, the poor, and the sick - these criminals cost US Taxpayers $60 Billion (with a B) a year. Tom Costello contributed this report this morning on the Today Show. Be sure to assess your practice for any compliance risks, implement a strong compliance policy, and maintain it. If you uncover any concerns about fraud or abuse, be sure to contact a compliance expert and consider self-disclosure. With the amount of federal dollars being recouped each year (last year alone the federal government recouped $4.5 Billion in fines, penalties, and restitution) you can rest assured that the government will be ramping up its efforts.
Mike Enos, CPC, CPMA, CEMC and Nancy Enos FACMPE CPMA, CEMC, CPC-I, CPC have authored a series of articles published in MGMA's Connexion Magazine. The September issue featured the first part in the Code of Conduct Section, and Part 2 has now been published in the October edition.
In the September article EMR Risk- If it wasn't done, don't document it: Tackling E&M coding errors in the age of EHR's we explored the growing trend of overdocumentation made easier by EMR's. We discussed the causes and risks associated with overdocumentation, as well as proper ways of documenting lengthy visits to make sure you are reimbursed appropriately. In this article, we investigate the pitfalls and risks related to overdocumentation and cloned notes specifically.
Cloned notes (using the exact same verbage from patient to patient), copied notes, and automatically generated notes should be examined closely, and physicians should be trained on how to delete, correct, and authenticate the contents of their notes to ensure that the notes actually reflect the services provided, and nothing more. Often times in copy-and-paste notes, or other EMR notes where information from previous services are "pulled forward" into the note, we find information that is erroneous, superfluous, and sometimes directly contradictory with what is described in the history of present illness or the examination.
EHR's that have a "coding tool" can be especially risky, when the level is calculated based on data elements, and not medical necessity.
CMS has approved complex audits of high level E/M services, following their May 2012 Report on improper billing and coding of high level Evaluation and Management Services.
Connolly has today posted on their web site their new audit scope related to E&M audits:
Impacts: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands, Virginia, West Virginia.
Mike and Nancy are independent consultants and coding educators. They are a mother/son team who are active in local and regional professional organizations.