Billing Errors & Omissions

Are you ready for a RAC Audit - we're here to help.

Due to the increased attention the US Federal government has placed on controlling the rising costs of healthcare, medical providers of all types are coming under increased scrutiny with regards to medical billing practices. For expert advice on RAC Audits and whether you have the appropriate Billing Errors & Omission insurance, call HealthCare Risk Specialists today.

According to a recent Centers for Medicare & Medicaid Services press release:

"The Centers for Medicare & Medicaid Services (CMS) has taken the next steps in the agency's comprehensive efforts to identify improper Medicare payments and fight fraud, waste and abuse in the Medicare program by awarding contracts to four permanent Recovery Audit Contractors (RACs) designed to guard the Medicare Trust Fund. In the Tax Relief and Health Care Act of 2006, Congress required a permanent and national RAC program to be in place by January 1, 2010. The national RAC program is the outgrowth of a successful demonstration program that used RACs to identify Medicare overpayments and underpayments to health care providers and suppliers in California, Florida, New York, Massachusetts, South Carolina and Arizona. The demonstration resulted in over $900 million in overpayments being returned to the Medicare Trust Fund between 2005 and 2008 and nearly $38 million in underpayments returned to health care providers.

The goal of the recovery audit program is to identify improper payments made on claims of health care services provided to Medicare beneficiaries. Improper payments may be overpayments or underpayments. Overpayments can occur when health care providers submit claims that do not meet Medicare's coding or medical necessity policies. Underpayments can occur when health care providers submit claims for a simple procedure but the medical record reveals that a more complicated procedure was actually performed. Health care providers that might be reviewed include hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers and any other provider or supplier that bills Medicare Parts A and B."

Is your practice prepared for a RAC audit?
Do you have Billing Errors and Omissions insurance? If so, is it adequate?
Does your Billing E&O cover RAC audits?
Does it cover fines and penalties?
Does it cover defense costs associated with RAC audits and potential defense of billing practices against CMS?

As one of the largest national medical liability insurance brokers, HealthCare Risk Specialists is uniquely suited to assist you in evaluating your situation, assessing your current coverage and recommending the best and most advanced products in the marketplace today. To discuss your options as it relates to your insurance coverage, feel free to call us at (toll free) 877-505-4277.

	TRADITIONAL INSURANCE PRODUCTS		SPECIALTY PRODUCTS
	Med Mal	D&0	MEDEFENSE™	NETGUARD™ PLUS
Defense Coverage for Medicare/Medicaid Audit Includes allegations of billing violations from Recovery Audit Contractor (RAC) and Comprehensive Medicaid Integrity Plans (CMIP)	Limited	May Be Available at Low Limit/ High Deductible	$1,000,000	Not Covered
Qui Tam Plaintiff (Federal False Claims Act)	Not Covered	Limit by specific policy definitions	$1,000,000	Not Covered
Unintentional Billing Errors & Omission Coverage includes unintentional acts made by providers or outside billing organizations.	Not Covered	$25,000	$1,000,000	Not Covered
Unintentional Release of Medical or Financial Data Statutes Include: HIPAA , Financial Services Act, Fair Credit Reporting Act, other state privacy laws.	Not Covered	$25,000	Not Covered	$1,000,000
HIPAA Proceeding-Governmental Provides defense of violation of HIPAA privacy regulations	Not Covered	May Be Available at Low Limit/ High Deductible	$1,000,000	$1,000,000
EMTALA Proceeding	Limited	$25,000	$1,000,000	Not Covered
Stark Violations	Limited	$25,000	$1,000,000	Not Covered
Breach of Computers or Network Security Includes: failure to prevent access failure to prevent identity theft inadvertent transmission of malicious code.	Not Covered	Not Covered	Not Covered	$1,000,000
Patient Notification/Credit Monitoring Notification is mandatory in the vast majority of America	Not Covered	Not Covered	Not Covered	Up to $1,000,000
Data Recovery All reasonable and necessary sums required to recover and/or replace data that is compromised, damaged, lost, erased or corrupted (First Party)	Not Covered	Not Covered	Not Covered	Up to $1,000,000
Regulatory Fines and Penalties	Not Covered	Not Covered	$1,000,000	$25,000
Multimedia Coverage Includes coverage for Copyright/Trademark Infringement, Libel, Slander, Advertising, and more	Not Covered	Not Covered	Not Covered	$1,000,000
Voluntary Self-Disclosure Allowed	NO	NO	Yes	Silent