Practice Management Alert

Plus, BCBS Rhode Island revamps contracts to focus on quality measures.

Prepare yourself: Starting August 27, 2012 CMS will begin its Recovery Audit Prepayment Review prepayment audits in 11 states, according to an announcement on the agency's Web site.

This program "... will allow Medicare Recovery Auditors (RACs) to review claims before they are paid to ensure that the provider complied with all Medicare payment rules," according to CMS. "The RACs will conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments. These reviews will focus on seven states with high populations of fraud- and error-prone providers (FL, CA, MI, TX, NY, LA, IL) and four states with high claims volumes of short inpatient hospital stays (PA, OH, NC, MO) for a total of 11 states. This demonstration will also help lower the error rate by preventing improper payments rather than the traditional 'pay and chase' methods of looking for improper payments after they occur. This demonstration will begin on August 27, 2012."

Originally, the Recovery Audit Prepayment Review demonstration projection, announced in November 2011, was slated to start on Jan. 1. CMS then delayed it until June 1, and then again to a vague implementation date of "summer of 2012."

To read more about the reviews, visit https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/CERT/Demonstrations.html

Blue Cross Blue Shield of Rhode Island and Care New England, a major hospital group in the state, reached a five-year plan that includes BCBS paying the hospital additional amounts based on quality measures. The two entities are reworking their contract to focus more on comprehensive, quality-focused reimbursements.

"We want to create incentives to better coordinate care and management of these patients, rather than keep them in silos," said Peter Andruszkiewicz, president and CEO of Blue Cross, in a statement.

The new contract, which Andruszkiewicz says will likely be effective by the end of September, will define specific metrics based on quality-related programs, including creation of a more patient-centered model for both maternity care and for behavioral health, according to Providence Business News.