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The primary goal for CMS must be to ensure that corrective actions are in place so that improper payments can be reduced, says GAO.
What are the Centers for Medicare & Medicaid Services (CMS) doing to ensure quality in the recovery audit contra...
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Virginia, West Virginia Also Added
Connolly Healthcare, the RAC for Region C, posted 20 new DRG Validation Issues to their list of CMS-Approved audit issues, on Friday, April16. The new issues include eight (8) MS-DRGs with very high Relative We...
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The first in a series of RAC 101 calls begins tomorrow. Are you still holding your breath waiting for the RAC shoe to drop at your facility?
As recently reported in RACMonitor, CMS has announced a schedule of informational meetings called, interestin...
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You all are probably aware about how remark code N432 is supposed to indicate RAC-related claims activity on your remittance advices, and that some problems related to this code have been happening for some providers around the country.
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This article highlights key similarities and differences and may not include all RAC region request forms posted or not posted on their Web sites.
You've Got Mail
In general, there are three separate letters that hospital providers can expect to ...
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Perhaps the most essential component of physician professionalism is the authority and autonomy to make a clinical diagnosis. As RACs, MACs, QIOs and other entities engage in the DRG Validation process, we have begun to see significant numbers of reversal...
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One of the open questions regarding RAC activity during the last several years has been, "will cases be referred to the OIG?"
We've known that the potential of fraud referrals being made was listed within the RAC scope of work, but there has been spe...
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ED. NOTE: The O'Connor Hospital ruling has generated significant interest at RACmonitor. In response to readers requesting more information, we asked Duane Abbey to weigh in on this crucially important issue for you.
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If there was ever a time to have your physicians download RACmonitorEnews, this Thursday's edition is probably your best bet as well as a smart strategy to secure physician buy-in for the RAC preparedness work you're doing.
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Interest continues to run high on the recently updated signature guidelines issued by the Centers for Medicare & Medicaid Services (CMS), as reported last week by RACmonitor.
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CMS has announced a series of "Nationwide RAC 101 Calls" scheduled for late April and early May.
(see http://www.cms.gov/RAC/03_RecentUpdates.asp#TopOfPage )
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President Obama signed the Patient Protection and Affordable Care Act into law on March 23, 2010. Reaction has ranged from jubilation to threats of violence.
Meanwhile, various public opinion polls conducted just prior to and after the enactment of t...
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By now, many if not most hospitals nationwide have begun to receive RAC requests based on the approved issues posted on their Web sites. All four RACs have been approved for issues related to MS-DRG validation and coding accuracy, and it is important to r...
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What would happen if you tried to ward off a werewolf with a clove of garlic? What if you tried to thwart a vampire with a St. Francis pendant?
I've seen a lot of monster movies during the last couple of months, and there's one thing I've learned: with...
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Two recent publications issued by CMS clearly indicate that the organization is tightening its requirements for the documentation required to support medical necessity and mandated signatures on prescriptions and orders for services.
The first public...
