Provider Must Be 'Vigilant'
Kim Looney, partner at Nashville-based law firm Waller, says provider organizations should pay close attention to HHS' annual Work Plan, which outlines new and ongoing reviews and activities that the Office of Inspector General plans to pursue throughout any given fiscal year.
"They release the plan every year, and it sets out what they are going to focus on," Looney says, stressing that providers need to know what is contained within the Work Plan. "That is part of being proactive. You can't ever let your guard down."
"[Providers] have to be so diligent and vigilant," she adds. "They have to be educated to know what the guidelines are, and if they change, they have to be aware of it."
Looney says it is important for providers to appeal denied claims for financial reasons, but also for the principle of the matter.
"You almost have to keep fighting or there is no reason for the RAC not to try to continue to take money back," she says. "If no one is going to argue with the RAC, they are going to keep denying claims."