Wednesday, June 10, 2009

RAC attack!!

Medicare, to the extent that it doesn’t pay for the care you are mandated to deliver, is a provider tax. Of late the folks at Medicare have decided that your tax refund in the form of Medicare fees may be excessive. So Medicare has contracted with “bounty hunters” in the form of Recovery Audit Contractors (RACs). This article from the Journal of American Physicians and Surgeons explains the program. Here are a few tidbits:

Medicare’s recovery audit contractor (RAC) program, the “bounty hunter program,” is now a permanent entity.

As the Medicare program is facing $34 trillion in unfunded liabilities, it is clear that government has promised more in Medicare benefits than taxpayers can afford long-term.

Those physicians who are holding out for a “fix” in the flawed Medicare SGR
(sustainable growth rate) payment formula should know that if a “fix” is implemented, it will likely come at the cost of the adoption of a DRG-like system of payment for outpatient encounters (episodes of care). The adoption of a DRG-like system of payment for outpatient encounters will, of course, ensure that patients who present to the physician’s office will be given the same type of treatment that patients receive in the hospital under the DRG (diagnosis related group) payment system.

(Just such a DRG-like system for the out patient sector was proposed in 1985 in the form of the Kennedy-Gephardt bill, which was defeated).

Here’s more:

Medicare is a giant Ponzi scheme that, like all such schemes, is destined for collapse. Despite repeated warnings of impending financial collapse by AAPS, the former head of the Government Accountability Office (GAO), the former Secretary of the Department of Health and Human Services, and the chairman of the Federal Reserve, the giant Medicare Ponzi scheme continues, and soon will take on the additional costs of the retiring baby boom generation. Aggressive RAC attacks are anticipated, and physicians will be targeted for substantial repayments in the coming years.

Will the coming RAC attacks be a disincentive for adoption or EMRs?

Physicians who adopt electronic health records (EHRs) will be facilitating RAC attacks by making more data available for RACs to mine, at low cost, using their proprietary data-mining software. Physicians using EHRs will be in a constant and costly race to upgrade their software so as to comply with ever changing Medicare rules and regulations that make physicians vulnerable to attack.

The end result for physicians will be increasing expense associated with treating Medicare patients in an environment of shrinking payments.

Here are some links from CMS, including a tentative audit schedule by region, a slide presentation about what it means to you and your practice, and some FAQs.

1 comment:

Anonymous said...

We are rapidly approaching the point where docs won't take medicare (except in hospital where we have no choice).

Eventually patients will start opting out (or more likely, paying more out of pocket) for care.