Published quarterly by RACmonitor, the Auditor Monitor is your desktop reference to the activities being executed by an array of government and third-party healthcare auditors. Each issue reports not only on the audits and the auditors but also on healthcare settings currently prone to auditing, including hospice and home health, as well as inpatient rehabilitation facilities (IRFs) and outpatient therapy providers. Each quarter, Auditor Monitor profiles a major healthcare auditing initiative, including prior authorizations, the Program for Evaluating Payment Patterns Electronic Report (PEPPER), telehealth, and the 340B Drug Program.
In the current edition of the Auditor Monitor, you will learn how the filing of a preliminary injunction saved a behavioral healthcare provider from having its Medicaid contract with the State of North Carolina terminated by a managed care organization (MCO). Had the MCO prevailed, the provider would have been forced into bankruptcy and closure since 98 percent of the company’s revenue flowed from Medicaid. Also in this edition of the Auditor Monitor, Mark Spivey interviews a nationally prominent consultant who is proposing to end the Two-Midnight Rule. As Spivey notes in his seminal piece, “with the three-year process of eliminating the Medicare Inpatient-Only List beginning at the start of the current calendar year, with about 300 of a total 1,700 services being dropped, an insidious question has started circulating in the minds of healthcare leaders nationwide, could the Two-Midnight Rule be next?”
As a healthcare professional you know that your facility is a target of audits by an array of governmental and third-party auditors operating to protect the Medicare Trust Fund from improper payments by facilities and providers for services provided to Medicare beneficiaries.
The Alphabet Soup That Can Get You in Hot Water
Consider for a moment, the alphabet soup of audit acronyms—MACs, RACs, ZIPCs, UPICs, QIOs, BFCC-QIOs, not to mention the SMRCs, and IRE—and then consider the power that has been invested in them to review your claims and make judgments that could impact your facility and its revenue.
Introducing the Auditor Monitor
Since 2008, following the announcement by the Centers for Medicare & Medicaid Services (CMS) to launch the national Recovery Audit Contractor (RAC) program, RACmonitor has been publishing the latest audit and compliance news for the benefit of hospitals, health systems, and practices. And now, RACmonitor is publishing a quarterly resource where you and your team can have the complete guide —and reference source—on the nation's healthcare auditors.
You will find the Auditor Monitor offers unprecedented insight and guidance, helping you navigate the rough auditing landscape. With clarity and precision, you and your team will have a resource that will help you and your team must be prepared to defend your organization from a continuing onslaught of audits in 2020 and beyond.
If you have any further questions or need technical assistance, please call 1.800.252.1578, ext. 2,
email Customer Care.