April 13, 2010

RAC BLACKOUT DELAYED – RAC WILL MOVE AHEAD WITH COMPLEX REVIEWS

The anticipated blackout period for the Recovery Audit Contractor (RAC) for Kentucky has been delayed.  Highmark Medicare Services, Inc. (HMS) was awarded the Medicare Administrative Contract (MAC) for combined Part A/Part B Medicare services in Jurisdiction 15 which is comprised of Kentucky and Ohio.  However, two protests were filed which have delayed the transition from the current fiscal intermediaries to Highmark.  Providers will eventually receive notification of the timeline for the transition once it has been determined.  The ninety day blackout period for the RAC will be defined once the transition timeline is set.  For now, all providers should anticipate the RACs are conducting business as usual and proceeding with their audit agenda.

CGI Federal recently posted new approved issues on their RAC website.  The announcement is further indication that 2010 will be a busy year for providers; particularly for complex reviews involving MS-DRG coding and DRG validation. There are over thirty-eight issues that deal specifically with MS-DRG and DRG validation.   Medical necessity reviews are specifically excluded from review at this time.  With auditors beginning the process of conducting more advanced audits, it is anticipated that RACs will attempt to find evidence of “upcoding”.  It is very resource-intensive to respond to complex reviews. Providers have only forty-five days to respond to the RAC notification.  In some instances, the information they are requesting may go back to October 1, 2007 so the medical records may be in storage, some may be on paper, and some may be electronic.   The complex review will require many more man-hours from providers than an automated review. 

Dean Dorton Ford recommends that providers visit the CGI website frequently and prepare for the complex reviews that are anticipated for 2010.  Here are a few simple measures to help you prepare and reduce your risk in 2010:

  • Review all approved issues for your region
  • Conduct internal audits for coding and DRG validation on the approved issues list
  • Physicians documentation remains key to successful for appeals – conduct documentation audits and education as necessary based on internal review and audit findings

In addition, the Office of the Inspector General (OIG) released a report in February of 2010 on the outcomes of the Recovery Audit Contractors’ Fraud Referrals.  It simply stated that during the Demonstration project, RACs identified over $1 billion in improper payments, yet only referred two cases of fraud to the OIG.  RACs do not receive any contingency fees for the cases they refer so there may be some disincentive for RACs to refer cases of potential fraud to the OIG.   RACs are required to report any cases of potential fraud that they identify; however, they must be able to identify fraud to refer it.  CMS is going to provide mandatory training on the identification and referral of fraud.  Also, the OIG recommends they implement a database system to track fraud referrals that arise from the fraud referrals from the RACs.

For more information please contact:
Pam Hicks
phicks@ddfky.com
859.425.7636

Hicks Pam 2

April 7, 2010

A RELIABLE SPAM E-MAIL SOLUTION

Are you tired of sifting through several spam e-mail messages just to find the one legitimate e-mail that was sent to you?  Has the shear volume of spam made your inbox unbearable?  According to Spam Filter Review (www.spam-filter-review.com), approximately 31 billion e-mail messages are sent per day.  Of those 31 billion, 12.4 billion messages are considered “spam” e-mail.  This means 40% of all messages are spam.  Other tracking methods indicate as much as 80% of all e-mail is spam or virus related.  This high volume of spam along with the added threats of e-mail based viruses, can be extremely expensive, time consuming, and annoying for today’s businesses. 

To solve the spam problem, the technology group at Dean Dorton Ford is pleased to announce its spam and virus filter screening service.  This technology is extremely effective against stopping spam before it ever makes it to a user’s inbox and is very affordable.  Long term statistics of the service have shown a 97% reduction in spam e-mail and is an effective tool for e-mail virus scanning.  We are so confident in the service that we will offer a free 30 day trial with no obligation or purchase. 

The DDF technology group also provides end to end IT network and desktop management, software accounting services, and technology project based support.  If you would like to learn more about the any of our services, or sign up for a free spam killing trial, please contact Chris Jones at 859-425-7685 or info@ddftech.com.  We look forward to solving your business’s technology problems.


Jones Chris

April 1, 2010

Unraveling the Uniform Prudent Management of Institutional Funds Act

On March 25, 2010, the Commonwealth of Kentucky adopted the provisions of the Uniform Prudent Management of Institutional Funds Act (UPMIFA).  This is designed to replace to existing Uniform Management of Institutional Funds Act (UMIFA).  What does this mean for you?

In 1972, UMIFA was adopted.  UMIFA was the first act of its kind and was designed to provide uniform and fundamental rules for investment of funds held by charitable institutions and the expenditure of funds donated as “endowments” to those institutions.  Essentially UMIFA supported two general principles: 1) that assets would be invested prudently in diversified investments that sought growth as well as income, and 2) that appreciation of assets could prudently be spent for the purposes of any endowment fund held by a charitable institution.  UPMIFA was enacted to build on those principles based on the experience gained in managing endowments over the past 35 years.

Investing Funds

UMIFA allowed endowments to invest in any kind of assets, to pool endowment funds for investment purposes, and to delegate investment management to other persons, as long as the governing board of the institution exercised ordinary business care and prudence in the investment related decisions.  UPMIFA builds on that original principle and provides stronger guidance for investment management to these governing boards.  It requires each person responsible for managing and investing an institutional fund to make investment related decisions “in good faith and with the care an ordinary prudent person in a like position would exercise under similar circumstances.”  It requires prudence in incurring investment costs.  Factors to consider in making investment decisions are expanded to include the following:

  • general economic conditions;
  • possible effects of inflation or deflation;
  • tax consequences;
  • how each decision plays into the entire portfolio strategy;
  • the expected total return from income and appreciation;
  • other resources of the institution; and
  • current and future needs of the institution

UPMIFA requires that an investment portfolio be diversified, unless special circumstances dictate otherwise.

Expending Funds

UMIFA brought about the concept of total return expenditure of endowment assets for charitable program purposes.  It permitted prudent expenditure of both appreciation and income.  In essence, asset growth and income could be appropriated for program purposes, subject to maintaining the “historical dollar value” of the fund.  Again, UPMIFA has built upon this concept and has eliminated the “historical dollar value” rule.  Because UPMIFA provides better guidance on the concept of prudent spending, it makes the need for a spending floor unnecessary.  UPMIFA states that “an institution may appropriate for expenditure or accumulate so much of an endowment fund as the institution determines is prudent for the uses, benefits, purposes and duration for which the endowment fund is established”.  UPMIFA set forth the following criteria to guide an institution in its yearly expenditure:

  • the duration and preservation of the endowment fund;
  • the purposes of the institution and the endowment fund;
  • general economic conditions;
  • the possible effect of inflation or deflation;
  • the expected total return from income and the appreciation of investments;
  • other resources of the institution; and
  • the investment policy of the institution

As you can see, these criteria mirror the criteria discussed in the “expending funds” section above.  The purpose of this is to unify investment and spending policies and decisions.

Release or Modification of Restrictions

The provisions of UMIFA only allowed for the release of restrictions on donations.  UPMIFA recognizes that donor intent exists and protects that intent more broadly than UMIFA.  UPMIFA provides a more comprehensive treatment of modification or release of restrictions on donated funds.  The reason for this is that history has shown us that sometimes restrictions imposed by a donor can become impracticable or wasteful or may impair the management of the fund.  UPMIFA allows multiple avenues to release or modify these restrictions.  The first and most obvious would be to have the donor consent to this release or modification.  UPMIFA also authorizes a modification that a court determines to be in accordance with the “donor’s probable intent”.  If a charitable institution in Kentucky has endowment funds that fall into this situation, you must file an application with the courts and the Attorney General must be notified and they may participate in the proceedings.

In the Commonwealth of Kentucky, if an institution determines that a restriction contained in a gift instrument on the management, investment, or purpose of an institutional fund is unlawful, impracticable, impossible to achieve, or wasteful, the institution, 60 days after notification of the Attorney General, may release or modify the restriction, in whole or part if the following criteria are met:

  • the fund subject to the restriction has a total value less than $50,000;
  • more than 20 years have elapsed since the fund was established; and
  • the institution uses the property in a manner consistent with the charitable purposes expressed in the gift instrument

As you can see above, UPMIFA has brought about significant changes in how endowment funds are to be managed, invested and expended.  It should greatly assist governing boards in successfully managing these funds and properly expending in accordance with their institutions mission and donor intentions.  The enactment of UPMIFA also has brought about new reporting requirements for those institutions that issue annual financial statements.  Please discuss these changes with your accountant.  If you are interested in reading more about UPMIFA you can visit www.UPMIFA.org

Sources for this article: www.upmifa.org and “KY SB 76 – AN ACT relating to management of institutional funds”.

For more information please contact,
Lance Mann, CPA
lmann@ddfky.com
859.425.6705

Mann Lance