You Should Know...
CMS Spanked Hard by the CBO
In response to the overwhelming evidence of massive, across-the-board overpayments by the government to MAOs, the CBO (Congressional Budget Office) released its report on coding compliance enforcement—and boy is it damning.
It estimates that a whopping 10% or 16 billion dollars of in inappropriate overpayments are being paid out to MAOs every year due to inaccurate code submissions.
That paints an enormous compliance target on every MAO, provider and clinician who cares for medicare Advantage patients.
The report further criticizes CMS for inadequate audit volume, poorly targeted auditing systems and, most importantly, failure to follow statutory requirements to fully expand the RAC program to include Medicare Advantage.
The ramifications for you could be harsh.
These types of analytic reports generally lead to rapid action (see the inadequate networks discussion above).
With such a damning report, not only is the reaction going to be very rapid, it's almost certain to go over-board.
Validation audits are going to accelerate.
Aggressive RACs are going to come online.
At the very least, your compliance costs are going to escalate.
With narrow margins everywhere, organizations are relying on their fat Medicare Advantage revenue to keep themselves afloat.
What’s going to happen when they have to return up to five years of those previously booked dollars?
To protect yourself, now is the time to focus on tuning up your compliance.
From personal experience I can attest that once you can prove your compliance credibility with the auditors, they'll go elsewhere for that low hanging fruit--and leave you alone.
Internal audits, givebacks, institutional leadership—there are many ways to get it done.
You have a brief window to get ahead of the compliance curve.
Use it with alacrity.
Use it wisely.