Recovery auditors (RACs), which had been primarily focused on the billing activities of hospitals, will expand their scrutiny to examine physician practices, reported American Medical News.
Of particular interest for RACs will be the so-called high-level patient evaluation code. It has been a trigger of past audits by program integrity contractors that have scrutinized physician practices, particularly those connected with ambulatory surgical centers.
Physician advocates concede that while auditors should be able to recoup unnecessary overpayments, many completely honest clinicians have been harassed as a result.
"If there is somebody out there who is committing fraud, that's not good for any of us, but in order for the system to work the best, this whole fraud and abuse process needs physicians to be invested," said Jack Resneck, M.D., a vice chair of the dermatology department at UC San Francisco and a chair of the American Medical Association's Council on Legislation.
"To the extent that RACs unnecessarily harass honest people in the process of looking for fraud, they are not going to have the broader physician community enrolled, which is really what's needed to weed out rare problems," he told amednews.
The Office of the Inspector General said it would focus in part on spreading its scrutiny of payments beyond hospitals and onto individual providers. In particular, it would investigate how affiliations between medical groups and hospitals would affect billing Medicare.
"We will determine the impact of non-hospital-owned physician practices billing Medicare as provider-based physician practices. We will also determine the extent to which practices using the provider-based status met CMS billing requirements," the OIG report said.
For more information:
- read the American Medical News article
- here's the OIG workplan report (.pdf)