Three Pilot Revenue Cycle Programs announced by Medicare
CMS will begin several new demonstration programs in the year 2012 whose purpose is to curtail improper Medicare payments.
California, Florida, Illinois, Louisiana, Michigan, New York, North Carolina, Ohio, Pennsylvania, and Texas will pilot prepayment reviews of claims, called the “Recovery Audit Contractor” (RAC) program, which will check for compliance on the part of the providers with the rules of Medicare. This program will also target certain claim types that historically have had more improper high payments. The RAC will initially focus on inpatient hospital claims for short stays, with additional claims to be selected by CMS.
In the second demonstration program, California, Florida, Illinois, Michigan, New York, North Carolina, and Texas will be required to gain authorization for certain medical equipment starting with power mobility devices.
The final demonstration program, Part A to Part B rebilling, is open to 380 hospitals nationwide who volunteered for the program. CMS will enable these hospitals to rebill for up to 90% of the Part B payment when a Part A claim is denied by a contractor on an inpatient short stay. These payments are currently denied in full when the incorrect setting is billed.