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With the permanent Recovery Audit Contractors (RACs) in motion, hospital teams are gearing up by formulating project plans to minimize financial exposure. Hospital resources are limited, and the need is high for customized and systemized strategies for im...
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ED NOTE: RAC Monitor published a brief article after a CMS Outreach Session on the RAC program in which questions were taken from attendees and answered by CMS. The session, conducted last June, created some general concern and confusion, and RAC Moni...
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They say a synonym is a word you use when you can’t spell the word you’re thinking of.
That may be true, but you certainly can run into trouble that way. The use of a word that is subtly different from another that is more accurate can be impor...
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By: Randy Wiitala, BS, MT (ASCP)Carol Spencer, BA, RHIA, CCS, CHDA & Barb Vandergrift, RN, BSN, MA
There's a new auditor in town, and its mission is to focus on the Medicaid program - just like recovery audit contractors (RACs) focus on the Medi...
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By: Ronald S. Connelly, JD, Principal& Christina A. Hughes, JD, MHP
An extrapolated demand can be devastating to a healthcare provider. What starts as a relatively small audit by a Medicare contractor can become a real nightmare if a few dozen retroa...
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The RAC program is now in full swing, and as reported in a special alert earlier this month, Florida providers have been receiving demand letters from Connolly, the RAC for Region C. Based on input from a provider that was willing to share information, on...
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The Nov. 20, 2009 Federal Register extensively addresses physician supervision requirements for provider-based operations. During 2008 and 2009, CMS has gone through a period of restatement and clarification of such requirements for both diagnostic and th...
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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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The Recovery Audit Contractor (RAC) is approaching. Where should your hospital's leadership focus its time and attention? The answer is medical necessity, because it's clearly a key RAC target.
Medical necessity lies within the case managemen...
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Providers have been scrambling to get their so-called RAC Tracking System in place. But did you know that Medicare contractors are mandated by CMS to have a Provider Tracking System (PTS)?
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CMS originally had planned a "town hall meeting" conference call for today (Nov. 5) to address appeals of Medicare payment denials under Section 935 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (Medicare Modernization A...
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By Ronald S. Connelly, JD, Principal,and Christina A. Hughes, JD, MHP When is a $10,000 Medicare claim worth $200,000?When the claim has been extrapolated.
Imagine that a Recovery Audit Contractor (RAC) audits 100 of your Medicare claims, denies payme...
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In the past, whether it was IL-372s, lab audits, evaluation and management documentation or old-fashioned fraudulent/abusive activities, a whistleblower (disgruntled employee) or other "labor intensive" source often was the catalyst for a long investi...
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SPECIAL BULLETIN---The CMS conference call on 935 appeals process, originally scheduled for November 5 has been canceled. The event was billed as a "town hall" conference call and the subject would have been on appeals of Medicare payment denials und...
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Florida outpatient therapy providers report receiving Demand Letters under the Recovery Audit Contractor Program from Connolly, the Region C RAC, according to Nancy J. Beckley, MS, MBA, CHC.
Beckley reports that Connolly was the first RAC to post CMS...
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From utilization review and case management to discovering the existence of a Provider Tracking System, our Thursday edition of RACMonitorEnews keeps a tight focus on RAC preparedness. And by the way, don't forget the 2010 OIG Work Plan.
Here's a tas...
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"When an order is written for ‘assign per-case management protocol' and the case manager doesn't see the patient until eight hours later, what is the status of the patient?" one Webinar attendee asked. Another attendee quickly typed a different ...
