News

By: Carla Engle, MBA Wolters Kluwer/MediRegs From CERTs to ZPICs, there is a host of Medicare and Medicaid auditing bodies, scouring for evidence of improperly paid claims as well as fraud and abuse. As you are preparing yourself for the RAC, you also need to be prepared for these and…
By Felice L. Loverso, Ph.D. No segment of the healthcare industry was hit harder than inpatient hospital rehabilitation by RACs during the demonstration project from 2005 to 2008. Individual hospitals had hundreds of Medicare claims retroactively denied and faced millions of dollars in recoupments. Most, if not all, of these…
By Ernie de los Santos DALLAS (April 21, 2009)--- Much like their forefathers would have done, scanning the vast Texas sky for the telltale signs of a gathering storm, providers in the Lone Star state are making plans to hunker down and ride out whatever is about to rain down…
Providers will be under a great deal more examination and scrutiny from Medicare and Medicaid auditing bodies that are scouring for evidence of improperly paid claims as well as fraud and abuse, reports Carla Engle, MBA, in this Thursday's edition of RACMonitorEnews. "Everyone is hurriedly getting ready for the inevitable…
By Ronald S. Connelly, Principal Powers Pyles Sutter & Verville PC In the first case of its kind, the powers of Recovery Audit Contractors and Administrative Law Judges regarding the reopening of hospital claims are central issues in a complaint filed in federal district court on behalf of a San…
By Patricia Dear Indentifying status correctly is not necessarily easy. It is difficult to get this process right. And it is extremely important to get the status correct and documented sufficiently, in order to protect reimbursements from RAC (and other types of) auditors and consequent recoupment.
By Megan Jones News that Part A & B data has started flowing to the RACs was probably the most pertinent information delivered last week when approximately 150 people attended the first CMS/RAC Region A Outreach meeting hosted by the Greater New York Hospital Association.
By Cheryl E. Servais, MPH, RHIA VP, Compliance and Privacy Officer With some providers reporting that they were receiving requests for hundreds of records at once from the RACs, CMS has placed limits on the number of records that a RAC can request. CMS, the agency that oversees the RAC…