Palmetto GBA is monitoring the number of RAPs that are auto-cancelled due to providers not filing a final claim. In accordance with Medicare regulations, contractors have the authority to revoke a provider’s privilege to receive payment on the RAP. Therefore, providers identified with a high number of RAP auto-cancels due to no final claim will be notified that their RAPs will be set to pay at zero percent. The payment suppression will continue until a Corrective Action Plan is submitted and the provider can demonstrate improvement in timely billing of final claims. We will not be withholding the RAP payment, we will simply not pay RAPs for these aberrant providers. The affected providers will only be paid for final claims.

Other providers that are identified to have RAPs auto-cancelled for no final claims that are below the acceptable threshold will be notified that their current billing practices are unacceptable and their RAPs are being monitored. If improvement is not noted within a reasonable amount of time, future RAPs may be set to pay at zero percent.

Reference: CMS Internet Only Manual (IOM), Publication 100-04, Chapter 10, Section 10.1.12

Posted on Palmetto GBA Website: http://www.palmettogba.com.  Last Updated 4/18/2013

Consider these robust numbers: On Wednesday, the feds charged 107 suspects with submitting $452 million in false bills to Medicare in seven U.S. cities. In the Miami area, 59 of those defendants were accused of trying to steal $137 million from the taxpayer-funded healthcare program.