Feds ease auditing reviews, anti-fraud efforts to surge

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Providers need to make sure that billings are accurate and defensible, says Leah Klusch.
Providers need to make sure that billings are accurate and defensible, says Leah Klusch.

Providers likely will embrace House legislation that eases billing reviews for operators deemed a low fraud risk. 

The measure follows an announcement by the Centers for Medicare & Medicaid Services to suspend some Recovery Audit Contractor reviews until the end of March. Both actions respond to mounting criticism against aggressive and time-consuming Medicare billing audits.

But providers who believe the feds are likely to dramatically reduce accountability efforts may be in for a surprise. 

By some accounts, healthcare fraud tops $50 billion a year. It's relatively easy to get away with it, given the huge volume of reimbursement money in play.

But while some providers are willing to take dubious reimbursement risks, ethical operators also can get snagged.

That's why it's important for operators to ensure that all billings are accurate and documented, according to Leah Klusch, RN, BSN, FACHCA, executive director of The Alliance Training Center Inc.

“CMS is serious about this. They're returning significant amounts of payments to the program due to issues with compliance and documentation processes,” she said.

“The rules are not rocket science. You need to make sure the bills match and people delivering care know definitions,” she added.