RAC Audit
HHS-OIG report “Recovery Audit Contractors’ Fraud Referrals.”
Leave a Comment (February 20, 2010): Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, directed the Secretary, HHS to conduct a demonstration project using Recovery Audit Contractors to identify and recoup Medicare overpayments. Unlike Program SafeGuard Contractor (PSC) and Zone Program Integrity Contractor (ZPIC) agreements, RACs were not tasked with performing..
read more →A Look at RACs — Part I: What Do Physicians, Home Health, Hospice, and DME Providers Need to Know?
Leave a Comment (June 25, 2010): The purpose of this series of articles is to assess the Recovery Audit Contractor (RAC) Program from the perspective of physicians, home health, hospice, durable medical equipment (DME) providers, and other relatively small Medicare providers. As many non-hospital providers will acknowledge, early cries of wolf by law firms and..
read more →A Look at RACs — Part II: How Should Physicians and Other Providers Respond to a RAC Audit?
Leave a Comment (June 28, 2010): In Part I of this series, we reacquainted you with the design and purpose of the now permanent Recovery Audit Contractor (RAC) Program. Although RACs largely focused on inpatient care during CMS’ demonstration program, RACs are a real threat to small providers that don’t have the intensive compliance programs..
read more →Look at RACs — Part III: What Should Physicians and other Medicare Providers Know about Appeals and Recoupment?
Leave a Comment (July 2, 2010): CMS’ Recovery Audit Contractor (RAC) program is now permanent and nationwide. As we discussed in Part I of this series, while small providers were largely ignored during the demonstration program, physicians, home health, hospice, and durable medical equipment (DME) suppliers should be on the lookout for increased attention. In..
read more →Region B RAC CGI Announces that it will Begin Review of Eighteen Projects that Involve Medical Necessity
Leave a Comment CGI Technologies and Solutions, Inc., (CGI), has announced it will immediately begin reviews on 18 newly approved projects that involve the medical necessity of selected inpatient DRG payments. A complete list of the issues currently being examined by CGI can be found on its website. http://racb.cgi.com/Issues.aspx Recovery Audit Contractors (RACs), such as..
read more →Region D RAC (Health Data Insights) Begins Medical Necessity Reviews
Leave a Comment (August 30, 2010): Introduction: Health Data Insights (HDI), the Centers for Medicare Medicaid Services (CMS) Recovery Audit Contractor (RAC) responsible for auditing health care providers in Region D, has announced it will immediately begin reviews on previously approved projects which involve the medical necessity of selected inpatient DRG payments. A complete list..
read more →Points to Consider When a ZPIC Extrapolates Alleged Damages
Leave a Comment Imagine a ZPIC, PSC, or RAC hands you a claims analysis rife with alleged errors, an indecipherable list of statistical formulas, and an extrapolated recovery demand that will cripple your practice or clinic. What steps should you take to analyze their work? Based on our experience, providers can and should carefully assess..
read more →CMS Authorizes Medicare Contractors to Accept Administrative Appeals by Facsimile and Secured Internet Transmission but Many Contractors have Yet to Implement this Change
Leave a Comment (December 14, 2010): Earlier this year, the Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 6958, titled “Guidelines to Allow Contractors to Develop and Utilize Procedures for Accepting and Processing Appeals Via Facsimile and/or Via a Secure Internet Portal/Application.” Health care providers and their counsel welcomed the guidance, anticipating..
read more →RAC Audits to be Extended to Medicaid — HHS Publishes Proposed Rules on Medicaid Recovery Audit Contractors Further Highlighting the Question, Is a Claim Ever Final? Providers Need to Understand and Take an Active Role in the Process.
Leave a Comment (December 17, 2010): The U.S. Department of Health and Human Services (HHS) recently published a Proposed Rule which extends the Recovery Audit Contract (RAC) process to claims under the Medicaid program. As background, the RAC process has been a part of the Medicare program since 2005, first as a demonstration project from..
read more →RAC Prepayment Reviews of Medicare Claims Are Coming
Leave a Comment I. Introduction: As you know, RACs play an important role in the identification of Part A and Part B overpayments. Since the inception of the RAC Demonstration Project in 2005, RACs have successfully identified a number of improper claims, denying payment for reasons ranging from mere technical errors to broad concerns about..
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