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ADVANCE Perspective: Respiratory Views

Deciphering Coding Conundrums

Published February 13, 2009 2:14 PM by Colleen Mullarkey

The Recovery Audit Contractor (RAC) demonstration program proved to be a great success for the Centers for Medicaid & Medicare Services. Medicare already has recouped nearly $1 billion from providers in the five states where the program was launched in 2005. And with tough times hitting everyone -including CMS - the government health care agency hopes to recover more cash by rolling out a permanent RAC program over the next year.

The program is temporarily on hold for right now, but Medicare is expected to move forward quickly in the first quarter of 2009 and complete the nationwide rollout by Jan. 1, 2010. Medicare's initial hope for the RAC program was to detect and correct improper payments in the its fee-for-service program. Now it seems the agency is relying on the recoupment funds to keep the agency going, as some experts have predicted Medicare bankruptcy in less than 10 years.

"Now is the time to prepare for increased scrutiny of your Medicare claims; the RACs will be in your state soon, if they're not already there," said compliance solutions manager Camille Cohen, MBA, MSW, CHC. It's also a great time to brush up on your coding so you're on top of your game for future claims. 

Of course, many health care providers are finding that's a difficult task with staffing shortages, the turbulent economy, and ever-changing Medicare policies. If you're feeling overwhelmed and need a helping hand, coding expert Ray Cathey, PA-C, MHA, FAHC, CHCC, may be able to help. Submit your coding questions about sleep medicine and respiratory care to get Ray's expert advice on the best way to bill. And check out Ray's responses to providers' common coding dilemmas.

To learn more about preparing your practices for RACs, read Cohen's article on the ADVANCE for Health Information Professionals website.


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February 13, 2009 4:23 PM

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