About This Blog
Welcome to the Marketing and Planning Leadership Council’s blog, Service Line Transformation. This blog serves as the primary communication channel for our Service Line Transformation Initiative, a special multi-year research effort dedicated to helping organizations prepare key service lines for risk-based payment. We will address challenges ranging from growth strategy innovations for key services lines to chronic care strategy, service line leadership, innovative approaches to service line marketing, and more.
For more information on the Service Line Transformation Initiative, or to send us questions, comments, or leads on innovative service line and care delivery models, please email Eric Sanford.
Last November, CMS announced an expansion to their Recovery Audit Contractor program called the Prepayment Review Demonstration Project. Unlike previous RAC efforts that retroactively reviewed claims for billing accuracy and appropriateness, the new demonstration would switch tactics to “prevent improper payments before they are made.”
CMS initially scheduled the demonstration, expected to more than double the amount of reviewable claims to 2.7 million, to launch on January 1, 2012, and targeted 15 inpatient DRGs, including spinal fusion and cardiac implant procedures.
Medicare’s Prepayment Review Demonstration: Everything we know so far