• CMS to Fold ZPICs and MACs into New UPIC Entities

    The Centers for Medicare & Medicaid Services (CMS) reportedly is developing a new integrity contractor called a Unified Program Integrity Contractor (UPIC). 

    These contractors will focus on both Medicare and Medicaid integrity issues, and the Zone Program Integrity Contractors (ZPICs) and the Medicare Administrative Contractors (MACs) will be folded into the UPICs, according to an email sent last Friday by Dianne De La Mare, vice president of legal affairs for the American

  • Five Years Wiser: Analyzing RAC Data to Mitigate Risk

    For some hospitals, this summer marks the fifth year of dealing with RACs. Nearly $2 billion has been recouped via complex medical record denials, representing the lion’s share of RAC activity.[i] Thousands of audits have been conducted

  • CMS Proposes Using a Time-Based Presumption To Review Inpatient Admissions

    The Centers for Medicare & Medicaid Services (CMS) has proposed a significant revision to the definition of “inpatient” in an attempt to clarify its policy on how

  • A Backlog of Appeals Prompts the Question: Should CMS Stop the Audits?

    “Because of a very heavy and ever-expanding caseload of appeals arriving in our office, we do not anticipate scheduling this case for hearing and decision until the last quarter of FY 2014. Many of the cases that we are receiving will not be heard and decided until the first and second quarters of FY 2015.”

    That’s what one administrative law judge (ALJ) from the Department

  • Preadmission Assessment Screening for the Inpatient Rehabilitation Facility: What Medicare Requires

    As we outlined in our previous article, RAC audits are focusing not only on the clinical issues that support reasonable and necessary care, but on the ability of inpatient rehabilitation facilities (IRFs) to meet the technical requirements of the rules and regulations that were updated effective Jan. 1, 2010. This article will outline the requirements for the preadmission