4 Ways to Thrive in the New Payment Environment
2. Fight the RACs
When it comes to collecting payments, RAC audits are another key trouble spot, according to Norman. As Medicare ramps up its efforts to identify and correct what it considers to be overpayments, it is becoming harder for providers to hang on to their reimbursements for care provided to Medicare beneficiaries.
"RAC audits in particular are challenging in their depth and breadth with the whole process to appeal," Norman says. "RACs have been a big challenge, even bigger than the revenue cuts that have come from Medicare."
Unlike many hospitals and health systems that don't fight RAC auditor findings, VHC has "taken the opposite approach, and we have been very aggressive, but it adds a whole new layer of cost to defend yourself and defend yourself well," Norman says.
"You have to get it right on the front end to collect, but you have to defend yourself on the back end, too. It takes more staff and more time," she adds.
Norman says VHC monitors its RAC appeals and "looks for trends that we can fix on the front end. We have a couple of integrity auditors, and their job is to follow up when we are seeing these trends… We have people who are working on the front end to see why we are not getting paid."
- As Medicare Advantage Cuts Loom, Disagreement Over Program's Stability
- Centralizing the Revenue Cycle Protects the Bottom Line
- Doctors Feel Pressure to Accept Risk-based Reimbursement
- CA Fines 8 Hospitals for Medical Errors
- Surgical Checklists Unused in 10% of Hospitals, CMS Data Shows
- Medicare Advantage Carriers See 'No Choice' But to Accept Cuts
- Physicians to Appeal 'Docs v. Glocks' Ruling in FL
- A Fresh Look at End-of-Life Care
- Heart Attack Patient Costs Skyrocket Beyond 30 Days
- Employers Weigh Risks, Benefits of Private Exchanges