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Health Data Insights (HDI), the CMS Recovery Audit Contractor (RAC) for Region D, has posted approvals for the review of both medical necessity and DRG Validation for previously approved and listed issues including 29 DRGs, effective Aug. 16, 2010.
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As reported in the Aug. 10 AHA News Now Daily Report, the Centers for Medicare & Medicaid Services' (CMS) New Issue Review Board has approved the first "medical necessity review" audits for Medicare's permanent Recovery Audit Contractor (RAC) program,...
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By: Carol Spencer, RHIA, CCS, CHDA and Jill Sell-Kruse, RHIA, CCS
ED. NOTE: This is the third in a three-part series designed to compare and contrast the “coding-state” manager’s roles andresponsibilities of today with the “data-state...
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By: Carol Spencer, RHIA, CCS, CHDA and Jill Sell-Kruse, RHIA, CCS
ED. NOTE: This is the second of three series of articles designed to compare and contrast the "coding-state" coding manager's role;s and responsibilities of today in contrast to ...
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ED. NOTE:
This is the first of a three-part series designed to compare and contrast the current and future states of coding and the coding manager's roles and responsibilities. The article below summarizes the movement from a retrospective review ...
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Following the lead of Connolly Healthcare, CGI, the RAC for CMS Region B, has posted an approved issue to review Inpatient Admission Orders.
CGI is the second RAC to post the issue. The wording is identical to Connolly’s posting of the same issue a...
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Saying that his goal is to reduce improper payments by $50 billion between now and 2012, President Barack Obama signed into law today the Improper Payment Elimination and Recovery Act, a bill he noted that was unanimously passed by both houses of Congress...
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A lot has happened since last month! Our first RAC request has been reviewed with findings returned, and we've now received our second RAC request. It's amazing how much can happen in a month's time.
As I had mentioned last month, our first RAC reque...
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With one RAC - HealthDataInsights, for Region D - having set its sights on readmissions as a possible target - could the other RACs have a collection strategy in the works?
Studies estimate that as many as 20 percent of hospitalizations are readmi...
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How are hospitals being affected by the Recovery Audit Contractor (RAC) program?
That’s a question that the American Hospital Association (AHA) wanted to answer in response to “a lack of data and information” from the Centers for Medicare &am...
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Unaddressed corrective actions by CMS represented $231 million during the RAC demonstration, according to recent testimony before a Senate subcommittee made public yesterday by the General Accounting Office.
In a prepared statement, "Medicare Recover...
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ED. NOTE:
On Tuesday, July 13th we published "Part 1" of "Recent Legislation Requires Refresher on Hospital Three-Day Payment Window". If you missed Tuesday's article, simply Click Here to read it now.
With the passage of the Preservation of Acces...
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ED. NOTE:
On June 25, 2010, President Obama signed into law the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (HR 3962). Among other provisions, this law clarifies Medicare's policy for payment of services pro...
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Relying on an age-old tradition, President Obama today is using the Fourth of July congressional recess to appoint Donald M. Berwick, MD, to head The Centers for Medicare & Medicaid Services.
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On July 1, Connolly Healthcare posted this on their Approved Issues Web page:
Issue Name: Inpatient Admissions without a Physician's Inpatient Admit Order
Description: Admissions to the inpatient setting require a physician's order in order ...
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The Recovery Audit Contractor (RAC) demonstration project from 2005 through 2008 resulted in almost $1 billion in overpayments being collected from providers. In 2009, talk of the anticipated dire impact of the nationwide rollout of RACs was all the rag...
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In recent weeks, two new reports gave us some insight into how providers have been responding successfully to audits through their appeals of demonstration project findings, as well as how the RACs have been impacting providers in 2010 via the permanent p...
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The benefits of pre-bill coding quality audits, in order to send a cleanly coded claim out the door the first time and avoid payment take-backs due to RAC, MIC or MAC activities, has never been more important than it is in today's compliance environment.
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A colleague of ours, here at RACmonitor, a colleague whose modesty keeps us from revealing his identity, is a straight shooter and for good reason: he served his country as an officer in the US Army. And he's also an Eagle Scout.
While a number of us...
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This past week the Office of the Inspector General of the U.S. Department of Health and Human Services (OIG) posted a report of a nationwide review of inpatient rehabilitation facilities' transmission of patient assessment instruments for 2006 and 2007.
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