Connolly Healthcare posted 29 DRGs for review of medical necessity on Friday, August 27 and edited some posts on their website today, leaving some MSDRGs posted in multiple issues, some of which are contradictory. An example is MSDRG 314, which as of ...
EDITOR'S NOTE: Lest we forget, at about 8 a.m. on what would be a fateful Thursday, Sept. 1, 2005, with thousands of flood victims beginning to fill the Superdome, Children's Hospital President and CEO Steve Worley turned out the lights at his facility, c...
Connolly Healthcare posted approvals Friday for the review of medical necessity for the same 29 MS-DRGs already cited earlier this month by two other Recovery Audit Contractors (RACs), as reported here in RACmonitor
Unlike those other two RACs, howev...
Although the Centers for Medicare & Medicaid Services (CMS) does not mandate areas for Recovery Audit Contractors (RAC) to review, it does "share" information with them and "encourage" them to consider non-RAC audit findings in making decisions about ...
Health Data Insights (HDI), the CMS Recovery Audit Contractor (RAC) for Region D, has posted approvals for the review of both medical necessity and DRG Validation for previously approved and listed issues including 29 DRGs, effective Aug. 16, 2010.
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On March 10, President Obama issued an executive memorandum to the heads of federal executive departments and agencies, directing them to "expand their use of Payment Recapture Audits, to the extent permitted by law and where cost-effective."
"Paymen...
The file drawer that I have dedicated to interpretations, congressional maneuvering, laws thwarted, laws passed, CMS clarifications and CMS instructions related to the 3-day Payment Window is overflowing like Snooki Polizzi in a leopard-print mini dress...
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CGI Federal, the CMS Recovery Audit Contractor (RAC) contracted for reviews of Medicare claims in seven states, posted approvals for the review of both Medical Necessity and DRG Validation for new and updated issues including 29 DRGs since Aug. 12. Of the...
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By Frank Sheeder, Esq. and Lindsey Bartula, Esq.
Responding to RAC reviews by focusing on coding and medical necessity is not enough; it leaves some good arguments on the table.
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Although Recovery Audit Contractors (RACs) are not currently evaluating facility evaluation and management (E&M) services, it may not be long before they do.
In the 2010 final rule for the hospital outpatient prospective payment system (OPPS), CM...
As reported in the Aug. 12 AHA News Now Daily Report, CGI Technologies and Solutions Inc., the Region B RAC contractor, has issued a list of the 18 medical necessity reviews that were recently approved for audit by The Centers for Medicare & Medicai...
As reported in the Aug. 10 AHA News Now Daily Report, the Centers for Medicare & Medicaid Services' (CMS) New Issue Review Board has approved the first "medical necessity review" audits for Medicare's permanent Recovery Audit Contractor (RAC) program,...
The Centers for Medicare & Medicaid Services (CMS) today issued the final regulations to implement improvements to the Payment Error Rate Measurement (PERM) for Medicaid and the Children's Health Insurance Program (CHIP).
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CMS has been inconsistent in reviewing states' rate setting for compliance with the Medicaid managed care actuarial soundness requirements, according to a report issued last week by the U.S. Government Accountability Office (GAO).
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A California provider's challenge to the RAC initiative ceased to gain ground in U.S. District Court as the hospital's summary judgment motion was denied and the Department of Health and Human Services motion for summary judgment was granted last week.
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As government auditors expand their lists of audit issues, medical records departments are working diligently to get healthcare professionals to improve their documentation.
And with good reason: Significant financial risks can be traced back to po...
As we all know, improper payments have been a favorite topic in Washington lately. But now at least some of the focus is aiming away from healthcare, since we've obviously been the federal government's guinea pigs via the RAC initiative. Today we're...
Starting in 2008, CMS raised the issue of physician supervision relative to on-campus and in-hospital activities at provider-based departments (PBDs). The physician supervision requirements had been dormant since the provider-based rule (PBR) initially wa...
