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.
This latest edition, you’ll learn about recent case law that loosens the tight rules of extrapolation—rules set forth in Chapter 8 of the Program Integrity Manual (PIM) that dictate the governing of statistical sampling and overpayment estimation. Also, in this edition of the Auditor Monitor, you will gain insight into the contentious “Two-Midnight Rule,” the federal requirement that inpatient hospital stays cross two midnights.
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.