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The recent announcement by CMS regarding its modification of additional documentation requests for institutional providers during fiscal year 2010 has generated considerable response from providers seeking clarification about tax identification numbers an...
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Providers in Florida have gotten used to all the jokes about our fine state, and in particular the one about the city of Miami being the epicenter, or ground zero, of Medicare fraud (cue up "Conga" with Gloria Estefan and the Miami Sound Machine).
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We all know that the RACs are here, but what should we be doing to be in the best position to minimize the stress that their audits could cause?
To answer that question, I spoke with Ted Anderson, FHFMA, CPA, who is the Controller for Highlands Regional ...
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Critical Access Hospitals (CAHs) are different - well, at least for Medicare.
Prospective payment systems like APCs and MS-DRGs are not used by CAHs. So does this mean that the RACs will not be interested in CAHs?
With a moment's reflection you will pro...
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We heard recently that the RACs submitted over 90 issues for CMS aproval, to begin their audits of provider claims going back to October 1, 2007. Before a RAC can officially conduct an audit for any issue, they must have it approved by CMS, and the is...
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By: George L. Kelley, MS, MBA
In preparing your facility for RAC reviews, our organization has supported and championed a data mining approach that will identify specific cases at risk for review by the RACs. Once these cases are identified, they n...
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This time last year, in the first RACMonitor edition, I discussed the potential rollout of the RAC recoupment process on a regional and state-specific basis. As we all are well aware, the original rollout plans never came to fruition, but I would venture ...
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In this era of reducing improper healthcare payments, providers obviously are gearing up for some major league defense against the RACs, ZPIC, MICs and other governmental auditing bodies by shoring up their coding and billing practices. But there also hav...
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"On your mark, get set, go!" ... Each of us at some time have heard and responded to this phrase, whether in our personal or professional lives. The phrase anticipates our action, or reaction to a "race" or challenge.
Those of us engaged in some aspect o...
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NOVEMBER 12, 2009----Representatives from both McKesson and Milliman will be joining in today's Webinar, "RACs' Use of Medical Necessity Screening Tools: Understanding the Criteria." The Webinar is scheduled for 1:30 PM ET.
Each has agreed to answer ques...
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Fall is a great time of year.If you live in Florida, you finally can open up your windows for some fresh air. If you live in New England, you are basking in the beauty of the changing leaves. If you live in the mountains, you are hoping for an early sn...
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Nurse Auditor
ED NOTE: Meet Patty Clark, RN, BSN, who became the Nurse Auditor responsible for appealing medical necessity denials in 2007 when the RAC demonstration program was at its height.
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(October 6, 2009) --- The Centers for Medicare & Medicaid Services (CMS) has announced that it will hold what it describes as a "town hall meeting" conference call on Thursday, November 5, on appeals of Medicare payment denials under Section 935 o...
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MONDAY, SEPTEMBER 21, 2009----DCS, the Recovery Audit Contractor for Region A, has posted its first CMS approved issues to its Web site.
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By Sandra L. Draper, RHIT, CCS
One of the first CMS-approved audit issues announced by RAC regions C and D involves the correct billing for bronchoscopy services. The issue focuses on several CPT codes that only should be reported once per each date ...
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I'm not much of a crafter. In fact, I have been hoping for years to compile a collection of my grandmother's Croatian cooking recipes as a gift for my mother, which in turn would be handed down to my daughter, but I just can't seem to get started. ...
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ED. NOTE: This is the fifth in an ongoing series being produced by Carla Engle for RACMonitor.
Deciding how your own internal processes are going to work once the RAC letters start rolling in is probably one of the most daunting tasks we all are grapp...
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In a somewhat surprise move Wednesday afternoon Connolly Healthcare, the Region C RAC, posted a new CMS approved issue regarding clinical social work services. “Clinical Social Worker (CSW) services rendered during an Inpatient Hospital stay are not s...
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By Bret Bissey, MBA, FACHE, CHC
Watching how we, as humans, react to threats is a fascinating experience.
From the time we were in elementary school we have seen how different people react differently to the same situation. Do you remember seeing y...
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By: Patricia Dear
A ‘vortex,' as defined by Webster's, is a "fluid flow involving rotation...(a) whirlpool; a situation regarded as drawing into its center all that surrounds it."
Since the RAC demonstration (2005-08) proved wildly successful ...
