Recovery Audit Contractors

Our Firm has an impressive record of assisting facilities with Medicare Fraud Audit and Medicaid Fraud Audit reimbursement issues and also defending them when faced with Government Fraud Audits. Over the past five years, Financial Consultants of Alaska &Washington has reversed $26 million of proposed take-backs and penalties demanded by Medicare and Medicaid on behalf of our facilities. Recently our firm overturned $6,000,000 on a fraud audit on an acute care facility.

Office of Inspector General (OIG) released its third in a series of compliance guides directed at BOARDS of health care entities. Increased scrutiny at the Board level will determine whether the Board has processes in place to effectively monitor compliance issues. Boards must become better educated on compliance and will be held accountable for their decisions-if they fail to do so, that will be evidence of a failed compliance program. OIG work plan includes high focus on Cost Report and fraud audits associated with cost reports. In addition to the base payments issues such as disproportionate share, sole community provider status, bad debt, CAH designation and provider based clinic designation will be under additional review. Health Data Insights (HDI) will be the RAC contractor for Region D which includes Alaska, Washington, Oregon, Montana, Wyoming, South & North Dakota, Utah and Arizona. Region D RAC s low contingency fee set at 9.49%. Expect RAC s to overcompensate by intensity to find more fraudulent claims. RAC Audits unlike pilot program facility cannot re bill on an outpatient basis the inpatient claims the RAC denied. MORE REASON TO DO YOUR OWN AUDIT AND REBILL CORRECTLY.

Financial Consultants of Alaska & Washington has highly qualified healthcare reimbursement consultants with extensive experience in preparing Medicaid and Medicare Cost Reports. Our firm has prepared CMS annual cost report for Acute Care, Long Term Care, co-located, Critical Access, facilities as well as Rural Health & Federally Qualified Health Clinics, Home Health Agencies, and Community Mental Health Care Centers. We have prepared more than 300 cost reports. We also prepare the Medicaid cost reports in several states. In conjunction with preparing and filing the cost report are reviews and responses to Medicare on the proposed audit adjustments

FCA&W prepares interim cost reports to assist a facility in making changes during the year.

Our firm can review the cost report filed by you or your consultant to look for improvements in Reimbursement or omissions.

Our firm has specialized in assisting facilities with obtaining their Critical Access Designation, and obtaining the best billing method from Medicare (option II).

For critical access facilities, the cost report strategy for higher reimbursement largely depends on where statistics, revenue, and cost are recorded. Our firm has assisted hospitals in achieving the highest reimbursement on interim rates and cost reports. Our vast knowledge of rural and community hospitals has proven beneficial in improving facility's bottom line. Our firm is willing to review your last cost report and highlight areas that can improve your reimbursement.

Critical Access facilities need to place emphasis on the Medicare interim reports. The purpose of the reports is to have Medicare pay your claims throughout the year, a rate that parallels the year end cost report rate. If a facility has a large receivable from Medicare on the cost report, they have lost the use of the money and the interest it would have accrued. On the other hand, if the facility owes a lot of money to Medicare at year end, their reserves may not be adequate to cover payback unless they develop a model that is updated quarterly.

Medicare allows Critical Access facilities to perform mini cost reports step downs to send in with the interim reports. This will give you the assurance that your quarterly rates will closely approximate the cost report payments.

Medicare and Medicaid Fraud Billing Audits are on all healthcare providers screens. The various audits, PERM, SURS, and CERTS that are being performed by Medicare and Medicaid have made it difficult for providers to deal with the complexity of all the fraud audits. Our firm was hired as reimbursement consultants on nine of those Medicaid and Medicare audits in the last five years. We have been able to overturn $26 million of requested overpayments. On several of the audits, our providers paid nothing back to the Intermediary.

Myers & Stauffer LC were the contract auditors who performed DMA audits in Alaska. The purpose of DMA audits for this period and the previous cycles of audits, have been to recover millions of dollars of alleged improper payments made to Alaska providers by the Medicaid agency. The audits that have been issued also include large fines and penalties.

The contract auditors make mistakes, do not find the supporting data, or they misinterpret the regulations, statutes, Medicaid manuals or Intermediarys practicing methodology. Frequently the auditors do not recognize the documents they are searching for.

Physicians, Physician Assistants and Nurse Practitioners training/appropriate codes/level of service documention = higher reimbursement.

Currently, our firm has been hired to perform feasibility studies for several Critical Access facilities that are looking to expand. Our firm assists with all documents required for a Certificate of Need.

Physician training identifying levels of service assisting grants/funding.

North to Alaska
RAC-Fraud Audit Compliance Projects
also result in capturing lost
charges increasing the bottom line (907) 790-1026