News

By: Leo D'Orazio, MBA, FACHE When the long-awaited announcement came, healthcare providers knew that CMS was on track to move the Recovery Audit Contractor program from the demonstration phase to a national rollout. On October 6, 2008, CMS selected four permanent RACs and made it clear that the RACs were…
December 15, 2008

RAC Alert!

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CMS to Answer Questions About Claims During the RAC Demonstration. CMS Gives Providers Email Address for Information CMS is advising providers to send any unanswered questions about RAC claims that are in the appeal process or that providers, for some reason, cannot answer to this email address: RAC@cms.gov.
Each of us at some time has heard and responded to this phrase, whether in our personal or professional lives. The phrase anticipates our action, or reaction to a “race” or challenge. Those of us engaged in some aspect of healthcare services will likely have heard or thought of the…
December 10, 2008

RACs: What Went Wrong?

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What RACs Saw That Providers Missed Assessing the progress made by Recovery Audit Contractors from March 2005 through March 2008, CMS says that most of the improper payments occurred because providers submitted claims to Medicare for services that were not medically necessary or were incorrectly coded, as well as a…
With the RAC program expected to roll out in February, healthcare experts are advising hospitals to begin preparing for impending audits.The best advise: begin preparing now by conducting internal claims audits using data mining or claims analysis software. Use software to carefully track the status of all pending claims audits.…
The Medicare program is a $276 billion operation. Every minute 9,579 claims are processed. The Centers for Medicare and Medicaid Services (CMS) are concerned about the accuracy of the payments made to providers. CMS data analysis indicates an error rate of 3.9 percent. While this does not sound like a…
How RAC Preparation and Your Compliance Program Can Work Together It is my pleasure to write my first article for the RAC Monitor. With over 25 years of healthcare management experience including 11 years in Healthcare Regulatory Compliance, with hospitals (as a Compliance Officer), physicians’ groups and the pharmaceutical industry,…
Old Solutions, Appellate Strategies No Longer Effective in Dealing with RACs As your facility starts to organize a RAC strategy, many firms will try and offer solutions to best deal with the impending audits. But the RACs present a situation where the old solutions of random audits, software or appellate…