Compliance – in 2003, section 306 of the Medicare Modernization Act 2003 authorized the Recovery Audit Contractor (RAC) demonstration project. This enabled designated, outside contractors to request and review hospitals’ Medicare submissions and retain a portion of any overpayment discovered. Due to the success of the program, the Tax Relief and Healthcare Act of 2006 required nationwide expansion by 2010. The Patient Protection and Affordable Care Act, which was passed in 2010, further expanded RAC audits to Medicare Part C and D, physician offices, and Medicaid.
BCE Healthcare Advisors assists hospitals and physicians in their preparation for contractor audits through its tracking tools, by educating physicians about medical necessity and appropriate clinical documentation, and making certain the entire record is legible, complete and could win an appeal. CMS supports the implementation of CDI programs as a positive step toward supporting medical necessity and appropriate reimbursement in light of the care rendered.
ICD-10 physician education is latest initiative to support the goal of appropriate documentation.