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By: Bret S. Bissey, MBA, FACHE
For the last three 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 Servic...
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By Duane C. Abbey, Ph.D., CFP
The RACs are allowed to use the statistical process of extrapolation, through which results from a limited sampling can be extended to a much larger universe. This process allows a RAC to perform a limited audit, yet reap...
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By: Linda Fotheringill, Esq - As if we don't have enough on our plates with the RAC Medicare Program, our Medicaid revenue undoubtedly soon will be subjected to similar harsh scrutiny.Please understand that as a taxpayer, I certainly am opposed to "fraud ...
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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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By Leo P. D'Orazio, MBA, FACHE
Medicare's RAC program is the first in a series of lightning strikes you'll experience during the billing compliance and claims reviews storm.
We all have been reading on RACmonitor.com about how CMS contractors,
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In June 2009, RAC Monitor published a brief article following a CMS outreach session on the RAC program in which questions were taken from attendees and answered by CMS, creating some general concern and confusion. RAC Monitor later was invited to intervi...
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It's that dreaded time of year for many of us - the time to tamp down our anxiety, put on a game (or should I say party) face and accompany the spouse to the spousal holiday office party.
There will be few folks you will know, plus some you wish you ...
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Recently, Connolly, Inc., the Recovery Audit Contractor (RAC) for Region C, announced the 24 MS-DRGs listed below as "approved issues." Connolly has now scheduled these MS-DRGs for DRG validation and discharge disposition review.*
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Automated reviews of outpatient topics and/or DME topics are underway across most of the country, and Connolly Healthcare, the RAC contractor for region C, in the first week of December released a set of 24 approved issues for DRG and discharge validation...
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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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Since my first RACMonitor article was published in December 2008, the hurry-up-and-wait strategy has been employed by CMS, as hospitals nationwide have scrambled to prepare themselves for the imminent RAC auditors. To date, there have only been a few st...
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ED. NOTE: In the article below that an astute reader has brought to our attention that MSDRG 372 has the description of MSDRG 373, and we anticipate that Connolly will address this on their Web site shortly as our reader has asked them to provide clar...
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(DECEMBER 2, 2009) - CMS has just modified the limits it set in October 2008 for the number of records that can be requested every 45 days. The announcement, posted today on the agency's Web site, suggests that in some situations the new system could resu...
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We're celebrating our first year anniversary. No need to send a traditional gift of paper. We're totally online. But we would like to acknowledge and thank those of you who sent us celebratory greetings as well as those who keep reminding us of the import...
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My first article for RACMonitor was published in December 2008, and I have been asked to reflect on what has changed relative to RACs during the past year.
I believe the issue that keeps impressing me most as we head into 2010 is that everywhere we look,...
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By:
Randy Wiitala, BS, MT (ASCP)Carol Spencer, BA, RHIA, CCS, CHDABarb Vandergrift, RN, BSN, MA
This year healthcare providers were introduced to yet another Medicare program with an alphabet-soup acronym, the Recovery Audit Contractor program (RAC)...
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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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The RAC Web sites are starting to post more information relating to the details of their complex review processes, to the benefit of providers everywhere. All but one (Connolly) of the RACs also has posted Frequently Asked Questions (FAQs), which reveal s...
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"Houston, we have lift-off..."
Your hospital can have a successful journey through the RAC audit process when the proper action plan is in place.
When you think about all that NASA has to do to prepare for one launch into space, the technical detail ...
