June 25, 2016

Looking Back, Moving Forward: The Weekend Edition for Saturday, June 25, 2016

By

Welcome to the weekend and thanks for checking in. 

We’re bringing you the news from the past week as well as providing you with a look at the week ahead. The biggest news this past week was the historic healthcare fraud takedown reported here on Thursday by Mark Spivey, RACmonitor national correspondent. Spivey noted that the 301 defendants slapped with civil and criminal charges included 61 doctors, nurses, and other licensed medical professionals accused of participating in the various healthcare fraud schemes. Twenty-three state Medicaid Fraud Control Units also participated in making the arrests, authorities said, and in addition, the Centers for Medicare & Medicaid Services (CMS) suspended payment to a number of providers using its suspension authority provided in the Patient Protection and Affordable Care Act.   

LOOKING BACK THIS PAST WEEK 

RAC Contract Closeout 

The status of the Recovery Auditor (RA) contract closeout continues to generate questions such as the one we received from Randy Neal who wrote: “I listen to Monitor Monday every week, appreciate the news and information. I was curious if you had any update on the RAC contracts.” Neal was referring to a posting on the CGI Federal website. On its site, CGI reports that July 29, 2016 is the last day that an RA can send notification of an improper payment to providers. CGI goes on to state the Aug. 28 is the date when RAs will complete all discussion periods that are in process by this date, noting that RAs will continue to hold claims for the required 30 days, starting with the date of the improper notification to the provider to allow for discussion requests. And finally, CGI says that Oct. 1 is the last day an RA can send “claim adjustment” files to the MACs.

Ronald Hirsch, MD, vice president of Accretive Physician Advisory Services, and a RACmonitor editorial board member and Monitor Monday panelist, offered this reply to Neal. 

“The fact that CMS posted a timeline for the wind-down of the current contracts does suggest that they are close to awarding the new contracts. A reliable source suggests that we can expect to see the new RACs up and running by Q4 2016. But a lot of the time frame depends on whether there will be a protest filed as there was in the past. If no protest, it could be earlier. I know that is not too specific but who really wants to speculate with the government?”

COMING ATTRACTIONS

Upcoming Webcasts

esMD: The Best News Yet from CMS

Complimentary Special Edition Broadcast
Sponsored by VYNE
Tuesday, June 28
1:30-2:30 PM ET

esMD, electronic submission of medical documentation, can cut turnaround time, reduce labor and hard costs, and even begin to realize significant financial savings. This exclusive webcast will feature Joyce Davis, deputy director for the Electronic Submission of Medical Documentation Program in the Office of Financial Management Provider Compliance Group. Rudy Braccili, Jr., MBA, executive director of revenue cycle services for Boca Raton Regional Hospital in Boca Raton, Fla. and Nicole Smith, vice president of operations and government services at Vyne. Register here.

Incident-To Services That Can Hemorrhage Your Facility and Physicians

Presented By Michael G. Calahan, PA, MBA
Thursday, July 14
1:30-2:30 PM ET 

Incident-to services are increasing, making them "low-hanging fruit" for federal auditing entities. Getting incident-to rules wrong can cost your facility or physician practice hundreds of thousands of dollars during federal audits. Learn the top ten federal audit targets have could ravage your potential revenue. Register here.

Outpatient Therapy Turmoil: Defend Your Facility Against an Auditing Onslaught

Presented By Nancy Beckley
Tuesday, July 19
1:30-2:30 PM ET 

Outpatient therapy is in turmoil. Providers are under siege by government and commercial auditors because so many providers simply don't know the rules that will keep them compliant. This webcast can change all that…for good. Register here.

Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the executive producer and program host of Monitor Mondays.

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