The RAC Audit Is Coming To Your Practice – Are You Ready?
February 28, 2009
So you got the notice the Medicare RAC is coming to your practice. No big deal? Think again. The CMS audit of all beneficiaries of Medicare payments (i.e. – those who file claims with Medicare) is here to stay and if your practice is out of compliance, it could end up costing you thousands of dollars. It’s not all gloom and doom, however.
Follow a few simple rules to help get your practice prepared.
First, a bit about the RAC. In 2005 Congress authorized the Recovery Audit Contractor (RAC) program to do a demonstration in California, New York, Florida and 3 other states. The purpose – to discover areas of fraud and waste and recover overpayments made by Medicare due to improper coding and compliance with Medicare guidelines. The result – over $900 million in overpayments recovered and returned to the Medicare Trust Fund. With the success, Congress authorized the RAC program to be rolled out to all 50 states and Puerto Rico no later than January 1, 2010.
Don’t expect it to go away either … this program is to be permanently in place.
Anyone who files claims with Medicare, physicians, hospitals, home health agencies and durable medical equipment providers are all affected. What does this all mean to you? If you fall into one of the above categories, expect a notice soon from the contractor in charge of the audit in your region. Don’t expect them to tell you what they are looking for, however. That is left up to you. The RACs are compensated on a contingency basis based on the amount of overpayments that they find. You think they are going to be aggressive? You betcha! The penalties for overpayments? At the very least, overpayments will have to be returned. And Medicare isn’t going to send you an invoice and wait for the money…they will just take a portion of your current and future claims payments until the overpayment is paid in full. In extreme cases, Medicare may suspend a practices claims privileges all together.
Protect yourself by following a few easy procedures.
First, consider conducting an internal assessment of submitted claims to make sure they follow CMS guidelines. Either you, your staff, or a third-party auditor can do this. However, a qualified third-party auditor may be the best option as this allows for someone outside your practice to give you a second opinion. If you do choose to do it yourself, look for claims that have been denied in the past and and review the RAC’s website.
Consider having a certified coder review a sample of your files and help you identify any pattern of inconsistent or improper coding. Again, a third-party audit service is an excellent option. A qualified auditor should have certified coders on staff, preferably with government auditing experience as well.
Comply with Medicare’s request for medical records in a timely manner. Failure to do so may cost you the right to appeal any decisions by the RAC that you disagree with.
Finally, implement corrective actions to ensure compliance with Medicare guidelines prior to the RAC visit to your office. The sooner you do this, the less money you will cost yourself when the RAC finally gets around to you. If you choose to use a third-party auditor to assist you, they should provide you with a report on areas for improvement as well as consult with you on other areas of compliance as well.
With the right preparation and implementation of processes, you don’t have to be afraid of the RAC. Besides, some good may come out of your audit. During the same demonstration in the above mentioned states, $38 million in underpayments to providers was made. You may find areas where you have been underpayed, so it isn’t all bad news.
You can read more about the medicare audit and our medicare audit service
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Affordable Health Insurance. Women, Learn How To Reduce Your Rates
February 22, 2009
In most other cases of Insurance, women get the better deal. But Health insurance decides otherwise. Why Women get higher rates than Men when it comes to health insurance is exactly what I would Examine here.
Consider the following.
There is a general consensus that Women tend to require more health attention than men. Why? Lets try to find out.
Every normal female experiences menstrual cycle. We all know that blood flows during this period and there are pysychological issues. From a particular age to menopause, this cycle continues apart from during pregnancy. So how many years of blood flow are we talking about? Does this have any implication on the health needs of women generally?
This is one issue.
To look at more issues, women also give birth to children. The period of gestation has its health needs but more than this, the after effect of the different pregnancies must have some kind of effect on their bodies resulting in a higher need for health care.
If we keep constantly in mind the fact that Insurance companies are not charitable organizations but businesses out to make profit, we would see why they need to take a lot of factors into consideration.
The insurance companies are concerned about how many people are likely to make a claim from a group, the amount claimed and the consequences to their business.
Lets try to make it clearer. If a certain percentage of a group of insureds make a claim, their overall rate must be such that the insurance company would still make profit. For example, 1 out of 100 insureds make a claim of $1000 and the the insureds pay a rate of $100, the company would still make profit and can even afford to lower the rates.
With this explanation, we would see that since women are known to generally claim on their health insurance more than men, they would necessarily be required to pay more rates than men.
Am I saying women can’t access affordable health insurance? No!
With the suggestions enumerated below, you would be sure to get a more affordable health insurance coverage.
Stop smoking.
Stop dangerous games and sports.
Any jobs that are hazardous should be avoided.
Lower your rates and increase your attraction by staying in shape.
Improve your health by doing regular exercises.
Engage in things that make you happy as happy people are less likely to fall ill.
One very important point is to, get and compare quotes extensively before taking up a policy. You would be able to get very affordable health insurance coverage.
With over 2,000 companies providing health insurance, you would surely have varying rates. So take your time and get the most affordable health insurance coverage.
Whether you pay more or less would be determined by the number of quotes you get. The more quotes you get, the more options you have.
Get Affordable health insurance coverage now and also get more information on how to get Affordable insurance coverage
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4 Trillion for Health Care By 2017?
February 18, 2009
From Gallup-Healthways Well-Being Index they have an article on their about by 2017 based on statistical information that is gathered every day – health care costs will be at 4 Trillion.
What’s worse is that 50% of that costs can be reduced by taking preventative measures such as dieting and exercise and just taking better care of ourselves. Makes me wonder if medical insurance is going to be nationalized what a huge amount of trouble for the government to try and help everyone.
A little information about Gallup-Healthways:
The Gallup-Healthways Well-Being Index is designed to be the Dow Jones of health, giving a daily measure of people’s well-being at the close of every day. With a daily measure, determining the correlation between the places where people work and the communities in which they live, and how it impacts their well-being, is now possible. Additionally, the Well-Being Index will increase an understanding of how those factors impact the financial health of corporations and communities.
When conducting the information they called 1000 people a day in 2008 so the information that they are sharing has good accuracy.
If we want to see medical insurance premiums not rise we need to do what we can to have the politicians increase awareness and provide incentives for people to be more healthy.
Maybe instead of bailing out health insurance for people money should be put in for healthier people. People could use a free membership to their local workout facility complements of the government!
A Vote For Eggs!
February 17, 2009
You have heard doctors go back and forth about whether eggs are good or bad for you. The study, by Drs Donald K Layman and Nancy R Rodriguez, is published in the Jan/Feb 2009 issue of the journal Nutrition Today
Apparently eggs provide a valuable contribution to helping your muscle development because of the protein that is inside. Eggs are also known to satisfy hunger and sustain your energy.
Maybe we can say that an egg a day will help keep the doctor away and lower medical insurance premiums?
Here is how eggs contribute to strength:
- As it does not cause surges in blood sugar and insulin, the protein in eggs is a steady and sustained source of energy.
- Eggs are rich in protein and nutrients including thiamin, riboflavin, folate, B12 and B6, the B vitamins that are essential for energy production.
- One eggs supplies more than 6 grams of high quality protein (about 13 per cent of the daily value) which helps to preserve muscle mass and prevent muscle loss in older adults.
- Eggs are rich in leucine, an essential amino acid that helps the body use energy and muscles recover after exercise.
- Eggs have all the amino acids the body needs to build and maintain muscle mass.
- Eggs are often used as the “gold standard”, a comparison for assessing the protein content of other foods.
I’m not too sure how medical insurance would like the idea of eating more eggs or not, however, today there is a vote for eating eggs – so eggs congratulations on possibly helping lower medical insurance because of your contribution to health.
Medical Insurance Quotes
February 13, 2009
Looking for medical insurance?
Cost of premiums going up?
Maybe it’s time to check out some quotes. Get a medical insurance quote free from MyMedQuote.net. The reason to get a quote is to see what is new out there.
You may be surprised that there are some plans that can save you money on your premium and yet still provide good coverage.
If you want to keep your premiums reasonable a good rule of thumb is to get a quote every couple of years to see what the premiums look like and make sure that you are not paying too much.
It will also be interesting to see what the United States government does to medical insurance in the future. I don’t think much will be happening in 2009 for help, but the works are underway for some type of health insurance reform.
Whatever the case MyMedQuote.net will still be able to quote medical insurance products for you. Even if that means that medical insurance goes into some type of supplemental program.
So what are you waiting for? Surf around the site here and get your medical insurance quote today.
Would You Like to Get Paid to Quit Smoking?
February 12, 2009
From the New England Journal of Medicine there was an interesting article about paying people to quit smoking actually worked. All quotes are from the article.
Methods We randomly assigned 878 employees of a multinational company based in the United States to receive information about smoking-cessation programs (442 employees) or to receive information about programs plus financial incentives (436 employees). The financial incentives were $100 for completion of a smoking-cessation program, $250 for cessation of smoking within 6 months after study enrollment, as confirmed by a biochemical test, and $400 for abstinence for an additional 6 months after the initial cessation, as confirmed by a biochemical test. Individual participants were stratified according to work site, heavy or nonheavy smoking, and income. The primary end point was smoking cessation 9 or 12 months after enrollment, depending on whether initial cessation was reported at 3 or 6 months. Secondary end points were smoking cessation within the first 6 months after enrollment and rates of participation in and completion of smoking-cessation programs.
Results The incentive group had significantly higher rates of smoking cessation than did the information-only group 9 or 12 months after enrollment (14.7% vs. 5.0%, P<0.001) and 15 or 18 months after enrollment (9.4% vs. 3.6%, P<0.001). Incentive-group participants also had significantly higher rates of enrollment in a smoking-cessation program (15.4% vs. 5.4%, P<0.001), completion of a smoking-cessation program (10.8% vs. 2.5%, P<0.001), and smoking cessation within the first 6 months after enrollment (20.9% vs. 11.8%, P<0.001).
What does this mean exactly? It means that this test company where they conducted this showed that more people actually quit smoking for good. The results shown that if they were able to quit for 6 months, then they are most likely able to continue to not smoke.
What does this mean for health insurance? If this were done in more large companies and it worked it would greatly reduce the cost of health insurance because most people realize the tremendous link between tabacco and cancer which costs an enormous amount of money.
Health insurance in a group setting usually rate up depending on how many unhealthy s there are in the group and I know of some companies that specifically give you a higher premium for being a tobacco user! So again enormous amounts of money could then be saved by companies and maybe even could convince the insurance company based on statistics to lower the premiums if all companies got on board, but it’s not a convincing enough study to know if it would really work long term or not. People are people of getting back into old ways and old habits so probably can’t count on it.
Maybe they can still use some of the economic bill to help get this going;) Ha Ha
Health Insurance for Nadya Suleman with 14 kids?
February 11, 2009
So you probably have read, heard or wathced the story about Nadya Suleman a Californian who had octuplets (which is 8 kids if you didn’t know). I got to thinking about the massive amount of cost it will be for her to have health care for these kids.
The unique thing about health insurance this that at some point adding kids to your policy is free and if Nadya does have health insurance I’m sure her company is trying to figure a way not to cover her.
The society response from this story has gone quickly from amazement to how can you be irresponsible. Can you imagine how much tax dollars will now most likely be spent on her and her family? Another question is whose fault is it really? Did her doctor fertilize too many eggs?
It also brings up the question of should their be a limit to how many children you can have in one family? My dad had 7 in his family.
WWHID (What Would Health Insurance Do?)
Can you imagine her trying to get private health insurance? I think the health insurance carriers would be frantically looking for a way to decline her or raise her premiums to unbearable. There would have to be some type of special form to fill out with 14 dependents.
The story is interesting and makes me wonder how a private health insurance carrier would handle her application. Does anyone have any thoughts?
Government Should Consider Canadian Health Care Before Nationalizing
February 10, 2009
If the economic stimulus bill passes which looks like it will, there is a portion in there that expands SCHIP funding to the states for children whose families are in a lower income status so that the children can have health coverage – and this is one step forward towards a nationalization of health care in America.
But before we get to this point I think that it’s necessary that the government takes a close look at the problems with the Canadian health care system so as to try and avoid making similiar misstakes.
According to an article by Kaiser entitled: Opinion | Obama Should Consider Canadian Health Care System ‘Hardships’ When Developing Overhaul Plan, Editorial States:
President Obama and congressional Democrats last week took a “first step … toward government-run health insurance” with the enactment of a law to reauthorize and expand CHIP, but they should consider “Canada’s experience” before “proceeding further,” Nadeem Esmail, director of Health System Performance Studies at the Fraser Institute, writes in a Wall Street Journal opinion piece.
He writes, “Health care resources are not unlimited in any country … and must be rationed either by price or time,” and as a result, when “individuals bear no direct responsibility to paying for their care, as in Canada, that care is rationed by waiting.” Esmail cites several “constitutional challenges” filed by Canadian patients placed on waiting lists for health care that “share a common goal: to win Canadians the freedom to spend their own money to protect themselves from the inadequacies of the government health insurance system.”
According to Esmail, the “experiences of these Canadians — along with the untold stories of the 750,794 citizens waiting a median of 17.3 weeks from mandatory general-practitioner referrals to treatment in 2008 — show how miserable things can get when government is put in charge of managing health insurance.” He concludes, “Canada’s system comes at the cost of pain and suffering for patients who find themselves stuck on waiting lists with nowhere to go,” and “Americans can only hope that … Obama heeds the lessons that can be learned from Canadian hardships” (Esmail, Wall Street Journal, 2/9).
I too agree that the United States needs to proceed with much research and cation because we don’t want to get ourselves into the same situation that many Canadians face each day.
Would you like to have to wait for medical care?
When is the last time you have been to the DMV? It’s going to be something similiar “take a ticket please” the only problem is that in the healthcare industry your ticket may last weeks before you get in.
What do you think the government should do?
Read Cheap Dental Plan
February 9, 2009
Is Cheap Dental Plans is a myth?
There seems to be a fear that is associated with the discovery of costs associated with dental insurance.
Would it surprise you to learn that dental visits account for roughly five percent of our amount health care needs in any given year? Since this is true, most insurance carriers will provide attractive rates associated with dental insurance.
For the business owner there are several avenues to consider when seeking to provide employees with dental insurance.
One of the key elements to their deliberation will center on overall costs. However, inexpensive coverage does not always equal a good plan.
Here are a few general types of coverage and what to expect:
* PPO Plans provide patients with a group of dentists who’ve agreed to provide care to patients within the group at a discounted fee. In essence the dentist is willing to receive less for the prospect of other patients.
* Self Insurance is an attractive option for businesses due to the fact that there is a strong potential for price savings if services aren’t utilized in any given year. The difficulty with this plan is the administrative headache that often follows it.
* Direct Reimbursement is similar to self-insurance. Employees are welcome to select their own dentist. The patient pays the dentist and is reimbursed by their employer. This approach is attractive to the employer because research shows that over 40% of employees may not require dental work in a given year providing a potential savings to the employer.
* Closed Panel plans are one of the most limiting in that they forbid the number of available providers. The patient doesn’t receive to select his or her own dentist.
* Indemnity Programs are much like many health insurance plans that let a choice in dentist. They also provide a limit on total coverage and co-pay options. The employer who monitors overall costs for the employee group generally show these.
* Capitulation provides a contract for service arrangement that pays a specific provider a specified amount each month to cover all treatment. That fee is paid even if no services are rendered.
Dental insurance can be affordable and a perk that will be appreciated by employees, but private coverage can also be obtained through a local broker or online. It will cost less than major medical coverage and can provide the peace of mind knowing your families dental needs can and will be taken care of.
If you choose your dental plan here. You will get these advantages:
* Join today & receive 3 additional months FREE!
* Save 10% to 60% on most dental procedures.
* Select from over 30 discount dental plans.
* Choose plans even offer discounts on prescriptions, vision, hearing and chiropractic services!
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Cheap Family Dental Care
February 5, 2009
Cheap Family Dental Plans Insurance Here.
Buying a family dental insurance provides you and your family two important benefits:
• Better oral health for the entire family as most plans pay 100% of the preventive service fees such as cleaning every six months. This encourages the family to visit the dentist for regular check ups and cleaning treatments. Prevention is half the battle!
• Generate more savings because the dental plan company pays a certain percentage of dental services for minor and major procedures.
Here are six questions to guide you in the selection of the right family dental for you and your family.
1. Does the insurance allow you to pick your own dentist?
Some dental insurance carriers give you bigger discounted rates provided you use their network of dentists. If your favorite dentist is not part of the network, the family dental insurance may not cover the treatment. You should consider paying extra for a plan, which allows you and your family to go to your preferred dentist.
2. Are there restrictions when it comes to choosing the best treatment options? Some family dental put a cap on the number of treatments or limit the amount paid for a condition. If you or your family has a history of poor dental health care, then you should choose a insurance that has few restrictions on this aspect.
3. What is does the insurance cover? An ideal family dental allows for one cleaning treatment every six months, with X-ray and fluoride treatments that come at little or no cost for each member. For the major procedures, some family dental plans require you to pay 50 percent of the entire bill. If your family has a history of good dental health care, then you may want to negotiate for lesser coverage when it comes to the major procedures.
4. Which family members are covered by the family dental plans? Most dental insurance carriers cover the spouse and dependent children, from birth through 18. Some exceptions are given for children up to the ages of 22 if the child is a full time student, and dependent on the principal for support.
5. Is there built in flexibility in scheduling dental appointments? Some inexpensive family dental plans limit when you can come in for dental treatment. Check to ensure that these scheduled appointments do not inconvenience you or your family.
6. How much savings does this plan generate? Whether you and your spouse decide to purchase family dental plans, or avail of your employers’ sponsored plan – you will still be able to generate savings, for you are not paying for the entire procedure.
Join the insurance today and get these advantages:
* Save 10% to 60% on most dental procedures
* The most dentists in combined networks anywhere!
* Choose from over 30 discount dental plans
* No health restrictions or paperwork hassles
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