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The new healthcare reform law-officially known as the Patient Protection and Affordable Care Act of 2010 (PPACA)-brings with it a new deadline of 60 days to report and return overpayments to the appropriate Medicare and Medicaid contractors. Not doing so ...
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In legislation that effectively ends the debate on whether hospitals can unbundle and bill any outpatient services that were provided within 72 hours of an admission, The American Jobs and Closing Tax Loopholes Act was introduced to the House of Represent...
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During the May 5, 2010 RAC 101 Conference Call, Scott Wakefield, a CMS RAC Project Manager for Region B stated that providers may begin to receive RAC medical necessity reviews "within the next month or so."
According to one listener with whom I spok...
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The Centers for Medicare and Medicaid Services' (CMS) permanent Recovery Audit Contractor (RAC) program began its formal rollout a few months ago, being required by law to be in place in all states by January 2010. Most hospitals are receiving requests fr...
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The Comprehensive Outpatient Rehabilitation Facility (CORF) is something of an orphan rehab program. A CORF is a Part A provider, and a sister to a rehab agency, sometimes known as an ORF. The CORF and rehab agency join the other outpatient therapy progra...
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As a physician reviewer for Washington & West, a denials and appeal management firm, my job is to examine medical records closely for documentation that will help me write a strong appeal letter. In so doing, I have the opportunity to see medical reco...
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The government is about to spend $600 million to fight healthcare fraud, waste and abuse. Some of those issues are criminal acts. If those 600 million dollars are not reason enough for a provider to review its compliance plan thoroughly, then I can list a...
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Officials from the U.S. Department of Health and Human Services and the Department of Justice announced new tools in the Affordable Care Act that would help fight fraud, strengthen consumer rights and protect taxpayer dollars.
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The Health Care Compliance Association held its annual conference April 18 – 21 in Dallas. The approximately 2,000 people who attended the conference were provided access to 35 programs that focused on various aspects of the stepped-up oversight activ...
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If you were one of the more than 2,000 people in attendance at the Health Care Compliance Association’s annual institute in Dallas this April, you probably were impressed, as I was, with the increased focus and energy that our government and enforcement...
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When CMS started the pilot RAC program several years ago, few providers outside of the demonstration states paid any attention, and some were ignorant of its very existence. A few more providers and organizations (very few) began to pay some attention whe...
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Although not identified specifically by the Centers for Medicare & Medicaid Services (CMS) as the reason for its recent attention to signature requirements, the findings presented in the November 2009 Comprehensive Error Rate Testing (CERT) report...
