RAC on the Go
“A Medicare auditor tasked with reviewing past claims for physician and hospital services in 15 states will start scrutinizing the billing of office visits, claims that previously had been off-limits to recovery audit contractors.” This is how the American Medical News article starts off. It says it all. The RAC or Recovery Audit Contractors are like hounds that have been let loose by the government. And this will not be pretty. As I have written about before, our coding system is a joke. That being said, we have to play the documentation game as it was given to us. Now the government, who set the rules, are after the “upcoders” and “cloners”. Godspeed to you docs out there. My prayers are with you.
And how stupid are the sheep that allowed the AMA and big insurance to do this. Stupidity and greed. A bad combination.
I am a busy internist, but see only 20-24 patients a day, while I know two others in my community who see 40+ a day. Now Humama, Untited health Care, and others are requesting my notes from 1/1/2011 forwards, looking for fraud. I have a simple answer for them. Show me the fraud. If they say, “In this complex patient where you addressed many conditions, and reviewed huge amounts of data,but you billed a 99214,and you didn’t have a social history in the note.”, then I will repay the difference in level of care, that the insurance company thinks it is owed. Then I will call the patient, and explain that their insurance company and I cannot work out an agreement on how to care for them. I will tell the patient I can no longer be their doctor. Yes I will do this. Every time. Why? You have no power with insurance companies. I will tell the patient that once they switch insurance companies, then, and only then, can they come back. I live in a physician shortage area. I fear in the big cities this won’t work because doctors have proven they cannot work together.