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Cain and Associates Launches Government Audit Protection (GAP) Service
Date:1/14/2009

Innovative Service Helps Hospitals and Health Systems Reduce the Likelihood of an Audit from a Medicare or Medicaid Recovery Audit Contractor

PHOENIX, Jan. 14 /PRNewswire/ -- Arizona-based Cain and Associates (C&A) (http://www.cainandassociates.com) today announced the launch of its new Government Audit Protection (GAP) service. GAP was specifically created as a pre-review process to assist hospitals and health systems minimize compliance and financial risks in light of new government Medicare and Medicaid recovery audit contractor programs. The initial and best known of which is the Recovery Audit Contractor (RAC) program. RAC began on October 6 in 19 states, and will be implemented in all 50 states by 2010. The RAC program concentrates on Medicare payments and allows third-party auditors to keep from 9.4% to 12.4% of payments identified as improper and then collect them from providers.

"Hospital executives must be proactive in this difficult regulatory climate and GAP is a perfect vehicle for self-auditing," notes C&A CEO Scott Cain. "In the initial audit test cases performed by RAC in California, Florida and New York in 2006 and 2007, almost $11 billion in faulty billings were uncovered. It's essential for providers to identify claims that were improperly paid, make voluntary refunds for payment and communicate the claims numbers to the carriers."

Centers for Medicare and Medicaid Services (CMS) is now mandated to vigorously collect overpayments and aggressively seek out provider fraud. According to CMS, most overpayments are due to "lack of medical necessity" and lack of documentation. The goals of the initiative are to identify past improper payments and recoup overpayments in the Medicare FFS program, as well as helping to prevent future improper payments thereby lowering the Medicare FFS error rate.


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