Big bad Medicare audits, or, being put on the RAC

By this point, pretty much everyone in the industry is aware that Medicare is stepping up the Recovery Audit Contractor program, under which contractors visit with providers and do a deep, hard audit of their Medicare claims. Without a doubt, this is going to be a hot topic at the show this year. After all, not only are doctors vulnerable, small practices are as well--in a particularly bad way--as few can afford to mount a vigorous fight if they're accused of owing big bucks.

Not only is Medicare expanding the RAC program, it's likely to increase the number of providers from which it wants money. After all, in 96 percent of RAC decisions, the contractor decides that the provider owes the government money. Worse, only a tiny percentage of RAC decisions were overturned on appeal. Scary stuff.

If you're among the worried, one option is to attend "Provider Beware: Protecting Your Company from Government Audits and Investigations," (CON 713), a concurrent session given by two attorneys. It is designed to help healthcare leaders identify the issues that typically trigger a Medicare/Medicaid audit or investigation, familiarize themselves with the legal risks a provider faces and demonstrate how a health care organization can defend itself during an audit or investigation. Folks, I think this one is going to be popular, so come early.