2015: The Lion is at the Door - DoctorsManagement 2015: The Lion is at the Door - DoctorsManagement

2015: The Lion is at the Door

By Frank Cohen, Director of Business Analytics | January 28, 2015

As originally published by Racmonitor.com

From my perspective, 2014 went out like a lion and 2015 has come in the same way, at least as far as post-audit extrapolation work goes.

Several weeks ago I picked up four new cases, and two of those (as have been a few others in the past) involve physicians who have split their interests between clinical practice and durable medical equipment (DME). It seems that DME continues to be a target for audits, and I’m not surprised, since a CERT study shows that some 60 percent of all DME payments are made in error.

Speaking of extrapolation recoveries, I am expecting to start seeing plenty of Part B extrapolation activity among the RACs. Remember, they are paid a commission, and up until now there hasn’t been any oversight with regard to the high rate of error reported on their end (by that I mean the excessively high rate of reversal of their findings on appeal). Think about it: the RACs have been on a feeding frenzy for the past few years, taking random bites out of thousands of providers, at times seemingly just hoping that they won’t appeal, yet knowing that if they do, their commissions go down the drain. What was their chief complaint during the contracting process? They wanted to make sure that they were paid on their findings and didn’t have to wait until after the final appeal. That’s exactly what I would say if my reversal rate were 70-plus percent.

Read the full article on Racmonitor.com