Government Targets Improper Payment – Ophthalmology Management

Although not specific to healthcare, the Improper Payment Elimination and Recovery Act was signed by President Obama on July 20, 2010. It expands the requirements for identifying programs and activities susceptible to improper payments with a goal of reducing and recovering them. This month, we will discuss how the Act impacts you.

This article answers the following questions:

  • Is there a report identifying the value of improper Medicare and Medicaid fee for service payments?
  • Do federal agencies publish advanced warning for services likely to be scrutinized?
  • What is a “CERT” audit?
  • How should I respond to a CERT record request?
  • What is the Recovery Audit Contractor (RAC) program?
  • May we appeal a RAC demand?
  • Has the Medicare claims appeals process changed?
  • Where can I learn more about the various levels of appeal?
  • Is there a way to mitigate potential overpayments in my office?
  • Are compliance programs mandatory?

This article was published in Ophthalmology Management’s Coding & Reimbursement column, which is written by Corcoran’s Executive Vice-President, Suzanne Corcoran, COE. To view the entire article in Ophthalmology Management, click on the link below:

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