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Cain and Associates Launches Government Audit Protection (GAP) Service

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) ( 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.

According to Cain, hospitals and physician practices are at risk for a potential audit. This includes hospitals, hospital administrators, subcontractors, physicians and consultants. GAP works to assess the company's exposure, and C&A will also work with groups in the appeals process if they have already been audited.

"GAP is one of the only services in the country with the ability to safeguard every group affected across the board and ensure compliance with RAC (Medicare) and MIC (Medicaid) audits," adds Cain. "As with all of our services, we are not a cost center, but rather, a benefit - we charge a minimal fee per account file reviewed or per bill appealed."

Cain and Associates takes technology and applies it to information to create revenue opportunities for hospitals. C&A's GRIP product insures that patients who are eligible for Medicaid coverage are identified. CORE uses proprietary data mining techniques and network access to capture commercial insurance eligibility information that generates additional funds for each hospital. In 2000, Cain and Associates began working with hospitals to execute their innovative services. So far, the firm has recovered over $20 million in lost revenue for their clients. C&A accomplishes this with proprietary software and consultation to perform the industry's deepest data querying and analysis.

Cain and Associates, LLC (C&A) creates revenue opportunities for hospitals through proprietary technology and information gathering techniques. They have saved hospitals millions of dollars serving clients in New York, Virginia, Maryland, South Carolina, Ohio and Kentucky. For more information, please visit or call (800) 817-2148.

Cain and Associates: The Business of Health Care

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