Part B Insider (Multispecialty) Coding Alert

Published on Sat Nov 06, 2010 PDF

Add yet another government audit contractor to your list, and this one may have slipped in under the radar. Back in 2008, CMS quietly hired Provider Resources Inc. in Erie, Pa. to double-check RACs. The RAC Validation Contractor (RVC), through reports issued to CMS, "ensures that the RACs are not unnecessarily denying Medicare claims which were properly paid," it says on its web site. "Similarly, our findings can also assure CMS that the RACs are properly recovering improperly-paid claims."

PRI also works with ZPICs on clinical review of medical records. "The results delivered by PRI staff are critical to the ZPIC process of identifying individual and systemic patterns of fraud, waste and abuse within the geographic boundaries of the ZPIC initiative," the contractor says.