I have to start this post off by being brutally honest. It’s a bit of a down week news-wise. Other than the fact that Palmetto GBA has now been designated as the MAC for Jurisdiction 11 (West Virginia, Virginia & the Carolinas), there isn’t much of grand importance to report in the world of medical billing. I hope the following paragraphs make sense to all of you. Maybe I’m sitting too close to my terminal today, but what’s below looks borderline insane to me. If you leave a comment, be kind and let me know how I did.
Seventy-three years ago today, the Golden Gate Bridge in San Francisco first opened to traffic.
Man-made marvels can be found all around the world, from the Eiffel Tower in Paris, to the Burj Khalifa in Dubai and the Empire State Building in New York City. For most of us, these assorted modern wonders stand as a testament to human achievement. Having said that, we have learned over the years that most structures of this type have a dark history. Grand designs such as these present dangers to the workers involved in construction, some of whom never live to see the grand opening. Once completed, they tend to attract people from the darker and more unrestrained recesses of the human condition. Nearly three-quarters of a century on, the Golden Gate Bridge has the distinction of being the most popular destination for those wishing to commit suicide on the planet.
Having internalized this bit of gallows knowledge, take the paradigm of buildings and structures as magnets for the unhinged and the sociopathic and apply this to anything that is created with the idea of serving the public good. Our system of law has created lawyers of the ambulance-chasing variety as one of its unfortunate side effects. Given the current state of the economy, one could make the argument that our banking system in its current configuration has attracted people that we don’t usually think of as the friendly, fiscally conservative bankers of years gone by.
In medical billing and compliance, specifically the Medicare and Medicaid programs, the existence of money supplied for public health payable to providers has had the unwelcome effect of attracting all manner of grifters, crooks and thieves looking to fatten themselves at the public trough.
Eliminating fraud and waste has been a CMS and OIG goal for quite some time. The final report for fiscal year 2009 shows a total of $2.51 billion being returned to the Medicare Trust Fund as a result of investigations. While that can be seen as positive news for the program, it should be viewed as small in comparison to the current stated backlog of nearly 2,800 cases of either health care fraud or civil health care fraud that are currently pending with the Justice Department.
Coming soon to this current climate will be the expansion of the Recovery Audit Contractor program to include state Medicaid programs. RAC’s present an interesting problem in that they aren’t particularly looking at one individual provider’s services or tendencies, but rather coding and reporting norms for certain types of services. I tend to think of RAC’s in the same way as I think about chemotherapy in that it holds the potential to eradicate the good with the bad. It is one of the unfortunate side effects to participation in a publicly funded health program that the honest members of the medical profession are very nearly presumed guilty until proven innocent.
Knowing that investigators cast a wide net can add to the anxiety of a practice who is following the rules to the best of their ability. We all have a common interest in eradicating the worst offenders from the medical delivery system, but it has been my experience that the majority of medical providers want to do the right thing. My advice to the above-board practices is to do their level best to surround themselves with people keenly attuned to changes both within the medical billing industry and their medical specialty. Be the physician who crosses over the bridge, rather than the one who leaps from it.