MEDICARE - MEDICAID - RAC

Medicare Audits With CMS constantly changing policies and procedures with regards to Medicare, we will guide and walk you through crucial issues like reasons providers get denied, the Medicare Appeals Process, Payment Recoupment and Recovery and standards for medical review to name a few. We fill you in on types of Contractors that conduct audits making you audit proof.

Medicare Audit Extrapolation CMS recently amended its subregulatory program integrity guidance to Medicare contractors with more specific instructions on when and how to use statistical sampling and extrapolation to report and return overpayments (“Transmittal 828”). We guide you on when and how to use statistical sampling and extrapolation to report and return overpayments. By statute, Medicare contractors may not use extrapolation unless there is a sustained or high level of payment error or educational efforts have failed to correct payment errors. 42 USC 1395ddd(f)(3)(A). CMS requires the use of statistical sampling and extrapolation when a sustained or high level of payment error exists and permits such methods after a documented educational intervention fails to correct payment errors. Let us walk you through this maze of rules and regulations.

Program Integrity Audits With CMS recently completely revamping Medicaid Program Integrity Manual, it becomes a tedious task for providers to stay up to date. Here at Resolute Solutions we simply this process for you. Independent third party inspections are more essential than ever before, and we will help your organization stay accountable with regards to your program’s eligibility claims being accurate and above par. Resolute Solutions will ultimately help protect your organization from waste, fraud and abuse.

RAC Audits The Recovery Audit Contractor, or RAC, program was created through the Medicare Modernization Act of 2003 (MMA) to identify and recover improper Medicare payments paid to healthcare providers under fee-for-service (FFS) Medicare plans. RAC AUDITS are primarily triggered by improper payments. The aim of the Medicare Fee for Service Recovery Audit Program is to identify and fix incorrect and improper payments in a variety of healthcare fields, home health and hospice included. RAC looks for both overpayments made to patients and underpayments made to providers. We help you take a focused look at previous RAC denials and learn where you may be vulnerable. We help enforce effective self-audits and provide you a tracking mechanism while double checking any impending deadlines.