Wednesday, Sept. 26, 2012
This Week's News
This Week's News
AMA to CMS: Halt expansion of Medicare RAC audits to E/M codes
Physician office visits may be under scrutiny as part of a new Medicare audit initiative the AMA is warning will lead to recoupment errors and costly appeals.
The Centers for Medicare & Medicaid Services (CMS) notified the AMA that Connolly, a recovery auditor for what is commonly known as the Medicare RAC program, will begin auditing how physicians report CPT® code 99215, used to report evaluation and management (E/M) services. CMS appears to have also granted Connolly authority to extrapolate its review of sample claims to potentially recoup funds on 99215 claims it did not evaluate individually.
In a letter to CMS, the AMA strongly objected to this practice and urged the agency to rescind its approval of E/M code audits.
"Because of the complexity of this type of care, it does not lend itself easily to medical review," the letter states. "Each E/M visit is different based on the unique needs of the patient."
The letter emphasized that audits of such complex services would result in erroneous payment recoupment and undue expense for physicians and CMS. According to the agency's own report to Congress, 46 percent of appealed Medicare RAC determinations are decided in favor of the physician or other health care professional.
During the past year, the AMA has made headway in improving CMS's burdensome audit practices. Just this summer, three congressional committees acted upon AMA recommendations and sent letters to the Government Accountability Office ordering a report on CMS's various physician audit efforts and a plan for streamlining them. Read more about the AMA's recommendations in a recent white paper.
The AMA continues to press CMS to withdraw this RAC expansion to E/M codes. Visit the AMA's Web page on Medicare RAC audits to learn more about recent improvements to the program, access auditors' contact information and view an archived webinar that explains best practices for physicians who have received an audit request.