AUDITS: Now Medicare 'Bounty Hunters' Will Receive Payment For Rescuing Yours

Why This Topic Matters

Audit activity and payment incentive changes can affect claim review, compliance risk, and reimbursement for physician practices. Understanding the policy direction helps practices anticipate areas of scrutiny and broader Medicare payment trends.

Article Sections

1. RACs and Medicare audit focus

   Overview of Recovery Audit Contractors, their Medicare role, and the move toward examining physician claims as well as hospital claims.

2. Incentives for finding underpayments

   Discussion of CMS changes to contractor payment incentives and the policy rationale behind looking for both overpayments and underpayments.

3. Targeted services and claim types

   General description of the kinds of outpatient and surgical services that may receive greater attention and the circumstances under which other claims could be reviewed.

4. Pay-for-performance concerns

   Summary of early discussion around pay-for-performance, including implementation concerns, technology costs, and future reimbursement implications.