Providers should prepare to face even more audits under healthcare reform, expert warns

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Providers need to have the appropriate staff and data analytics programs in place to defend against the onslaught of more Medicare and Medicaid claims audits, an expert urged.

As more provisions of the Affordable Care Act are implemented, Medicare and Medicaid providers should expect more scrutiny from Recovery Audit Contractors (RAC), Medicare Administrative Contractors (MAC), and comprehensive error rate testing contractors, according to healthcare management expert Robert Freedman.

The healthcare reform law expands the reach of RAC and MAC audits from Medicare to Medicaid, as well as Medicare Part D and Part C. Nursing homes increasingly are being targeted for audits.

In a web conference held Tuesday, Freedman said provider compliance officers should be prepared to spend a lot more of their time appealing and defending audits, according to a report by the Bureau of National Affairs. Data mining and data analytics programs can help providers make sure their billing operations don't stand out, Freedman advised.

“Providers are going to face challenges getting the right staffing and resources to handle audits. Data analytics will be important, and providers will have to learn to work smarter,” Freedman said.