Wednesday, May 30, 2012
This Week's News
AMA advocating for physicians' interests in all 50 states
Senate approves bill addressing drug shortage, antibiotic resistance crises
AMA member appointed to Medicare congressional advisory panel
Changes to federal fraud and abuse programs ease physician burden
This Week's News
Changes to federal fraud and abuse programs ease physician burden
Recent modifications to Medicare and Medicaid integrity programs should reduce bureaucratic hurdles physicians face and ease the administrative burden associated with audits, thanks to AMA efforts outlined in the latest edition of the AMA's Health System Reform Insight.
For instance, changes to the Medicare Recovery Audit Contractor (RAC) program will minimize the expense and administrative requirements for physicians undergoing an audit. Among the improvements are a limit of 10 medical record requests within 45 days to small physician practices, a lost fee if the contractor does not complete the review within 60 days and a "discussion period" during which physicians may speak with a RAC medical director about an audit.
Similarly, the Centers for Medicare & Medicaid Services has established guidelines based on AMA recommendations for the new data analytics program to identify fraudulent activity. These guidelines will protect honest physicians from undue hardship:
- Prompt payment will be waived only in exceptional and urgent circumstances.
- Clinical experts across the country and of every specialty will work with CMS on claims review.
- CMS is not denying claims based solely on the program and will develop models that do not disrupt claims processing.
