Medicare To Verify Necessity Of More Medical Billing Claims

There is currently a medical billing demonstration taking place that may lead to increased medical necessity reviews. Currently, the states of New York, California, and Florida are involved in a pilot demonstration led by the Centers for Medicare & Medicaid Services. The Centers for Medicare & Medicaid Services has hired a Recovery Audit Contractor (RAC) to do extensive evaluation of medical billing claims for three years. You may be asking: What does this medical billing audit mean to your practice?

If the demonstration in these three states is successful and the Centers for Medicare & Medicaid Services are able to recover money in medical billing overpayments, it could mean a lot to your practice. It would mean that the Recovery Audit Contractor can go through and check all of your medical billing records for the three year demonstration period. This means that in 2008, you could still be responsible to pay back medical billing overpayments from 2005.

The Recover Audit Contractor process is made up of three tiers. First, they will investigate Medicare Part A DRG reviews. This means they will look at the medical billing and request medical records. Second, the RAC will use data mining systems to check for overpayments. The third tier deals with Medicare Part B services. They will request medical records as well as medical billings for these services.

There is no question that your medical billing should always be accurate, but this just puts added pressure on billers. To ensure your practice not only performs correct medical billing procedures, but also receives correct reimbursement, hiring an outside medical billing firm would be to your benefit. Medical billing companies can help ensure you will not have to pay back money for a service three years past.

View all Articles by: Melissa Clark, CCS-P