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By: Bret S. Bissey, MBA, FACHE
For the last two articles I have written for the RAC Monitor, we presented a thesis that the elements of a Model Compliance Program, as detailed to us on numerous occasions by the Department of Health and Human Services...
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By Patricia Dear
Medicare patients increasingly fall into a "medical necessity" gray area between inpatient admission and observation/outpatient designation.
Often, however, and much to the chagrin of hospital providers, this becomes more of a payer/con...
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EDITOR'S NOTE: The recent CMS Special Open Door Forum for Part A providers conducted by CMS as an audio conference call is being reported by Ernie de los Santos in a two-part series. Part One: CMS Talks About Discussions, Denial Codes, Medical Necessity, ...
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By: Bret S. Bissey, MBA, FACHE
For several articles I have written for RACMonitor, we presented a thesis that the elements of a model compliance program, as detailed to us on numerous occasions by the Department of Health and Human Services and the Offic...
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By: Patricia Dear
I recently conducted a live Webinar for RAC University, titled "Protecting Reimbursement from the RACs: How to Avoid Medical Necessity Errors for Cardiac Service One-day Stays."
We had many facilities and physicians ask good q...
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By Carla Engle, MBA
We're all in a hurry-up-and-wait mode.
The past month has seen a flurry of activity: HCCA's annual conference in Las Vegas, several open-door CMS forums regarding RACs, and outreach sessions held around the country by RACs.
Yet w...
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By: Nancy J. Beckley, MS, MBA, CHC
It wasn't the Million Man March or "Mr. Smith Goes to Washington."
It wasn't even as thrilling as a high school trek to our nation's capital, but it was exciting to participate in an annual lobbying effort as part of t...
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By Samuel A. Donio, Jr., MBA, and George L. Kelley, MS, MBA
As the reality of RAC reviews sets in, concern for identifying a tangible dollar impact is beginning to move to the forefront of the minds of the C-Suite.
Up to this point, impacted fac...
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By Leo Paul D'Orazio, MBA, FACHE
The RAC auditors are thirsty. They are looking for that long, cool flow of cash wherever they can find it.
And if your facility is a geyser of improper claims payments that are dripping with recoupment opportun...
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By: Ernie De Los Santos
The Centers for Medicare & Medicaid Services (CMS) has cancelled four RAC Outreach Sessions scheduled for Texas in May over concerns about the H1-N1 flu virus.
None of the sessions were rescheduled, despite the need for almos...
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By: Patricia Dear -
In sports, business and most aspects of our work and lives, it is important to really know your opponents! Much is being written about RACs, how and when to prepare for them, and who is and will be impacted. You already should kn...
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By: Jeanine M. Tome, RNC, MSN, ACM, CPHQ -
The permanent RAC program rollout is curious indeed.
We have learned a great deal from the very real descriptions of anguish and financial impact, responding to the RAC demonstration project record request dem...
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By: Nancy J. Beckley, MS, MBA, CHC
Dateline Miami: the epicenter of Medicare fraud, ground zero of Medicare crookdom. Ah, Miami: the cool blue waters of the Atlantic Ocean, the bright sidewalks of South Beach, fast cigarette boats, even faster Italia...
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CMS has issued its proposed rules for FY 2010, offering few changes, but at the same time proposing low payment updates for acute-care and long-term care hospitals. All of this makes us emphasize with providers the importance of protecting what is theirs ...
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By Cheryl E. Servais, MPH, RHIA - VP, Compliance and Privacy Officer
The Scope of Work (SOW) for the permanent RAC contractors contains a section that allows RACs to utilize extrapolation procedures to determine overpayment amounts that may be due t...
