RAC 101: Class Is in Session

BALTIMORE — Think you know all about the Recovery Audit
Contractors? If not, CMS has scheduled a series of “RAC 101” calls
for home medical equipment providers and others:

• Nationwide RAC 101 Call
  April 28 1:00-2:30 p.m. ET
• RAC 101 Call for Home Health and Hospice
  Providers
  May 4 1:00-2:30 p.m. ET
• RAC 101 Call for DMEPOS
  May 5 1:00-2:30 p.m. ET
• RAC 101 Call for Physicians
  May 12 1:00-2:30 p.m. ET

To listen in on any of the calls, dial 877/251-0301.

According to industry consultant Wayne van Halem, this could be
only the beginning.

“In all the years I have worked in the health care arena, there
has never been a time when the government has been more intent on
reducing improper payments in Medicare and Medicaid,” van Halem
said. “Coupled with current health care reform initiatives, that
has made auditing the providers that bill the federal government a
primary focus.”

Specifically, van Halem said, the government increased the FY
2010 budget to strengthen existing Medicare and Medicaid program
integrity activities, including auditing — by some 50 percent
over spending in 2009 — to $311 million.

“In any federal budget, that is a significant increase,” said
van Halem, president of The van Halem Group, Atlanta.

What that boils down to, he said, is “that there will be more
auditors conducting more audits. We are already seeing the effects
of this with the expanded RAC program and transition to the Zone
Program Integrity Contractors.” (For more on ZPICs, see ZPIC Audits Newest
‘Business Buster,’ Stakeholders Say, Jan. 25.)

The best defense? “Offense,” stressed van Halem, who has worked
as a fraud analyst, a Medicare fraud information specialist and
senior investigator. “Get prepared.”

For van Halem’s insights and advice on audits, how to prepare
and what to do when (not if) they happen to you, check
HomeCare’s April issue, coming soon.