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The Medicaid Recovery Audit Contractors (RACs) could be gearing up to hit providers if one contractor’s quarterly report is any indication.
PRG Schultz International’s quarterly report for the quarter that ended June 30 noted it was awarded Mississippi’s Medicaid RAC contract and stated that it will “evaluate and bid for additional Medicaid RAC opportunities.” It also states that “while the magnitude and timing of additional health care claims recovery audit revenues are difficult to predict, we expect those revenues to increase in the third and fourth quarters of 2011 compared to the first half of the year.”
Other Medicaid RACs are less direct but also show an expectation of revenue in the coming months and 2012. HMS, which is the Medicaid RAC or subcontractor for at least seven states including New York and Tennessee, expects “a very promising pipeline for 2012,” said CEO Bill Lucia in a statement about the company’s second-quarter report.
Two Medicare RAC Issues Posted
On the Medicare side, RAC regions B and D saw new issues posted recently. They are:
Part B
|
Name of issue |
Date posted or approved |
Regions/states where it is active |
Description of issue |
Document sources |
|
Mohs surgery with pathology billed by separate provider J2 |
7/22/11 |
Alaska, Ore., Wash. |
If the preparation and interpretation of the slides of tissue taken during the Mohs surgery are performed by someone other than the surgeon or his or her employee, then Mohs surgery may not be billed. |
LCD L23735 effective with date of services performed on or after April 1, 2008 |
Outpatient
|
Name of issue |
Date posted or approved |
Regions/states where it is active |
Description of issue |
Document sources |
|
SNF consolidated billing |
7/26/11 |
RAC Region B |
Services are being billed separately that should be included in the skilled nursing facility (SNF) consolidated billing. Consolidated billing is when services provided during the resident's stay in a SNF are bundled into one package and billed by the SNF. Under the consolidated billing requirement, a SNF itself must submit all Medicare claims for the services that its residents receive (except for specifically excluded services). |
CMS Pub 100-04 |
Karen Long blogs regularly at RACMonitor.com.
