Therapy hours could go down and depression to go up at SNFs. A depression diagnosis is often hard to make. Clinical depression can be demonstrated in many ways and requires the subjective findings of a clinician. Some clinically depressed individuals seem to withdraw, while others can become irritable or even…
Five areas of concern are noted by the author. In the first part of this series, we examined audit risks associated with observation claims. We should review what other risk areas providers might expect and why, as Recovery Audit Contractors (RACs) ramp up reviews again. According to Centers for Medicare…
Concerns are related to observation claims. By now just about everyone has surely heard about Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma’s blog post on May 2, 2019. In the post, Verma asserted that CMS would require Recovery Audit Contractors (RACs) to “maintain a 95 percent accuracy…
Understanding why there’s a need for auditing the auditors. I frequently encounter complaints by healthcare providers that when they are undergoing Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), and, more recently, the Targeted Probe-and-Educate (TPE) audits, the auditors are getting it wrong. That’s as in, during a RAC audit,…
Last week the Centers for Medicare & Medicaid Services (CMS) released a blog post from agency Administrator Seema Verma titled “Recovery Audits: Improvements to Protect Taxpayer Dollars and put Patients over Paperwork.” In the post, Ms. Verma talked about the Recovery Audit Contractor (RAC) changes CMS made back in 2015,…
Verma acknowledges lingering gripes about the RACs, pledges to do better. In touting the federal government’s efforts to make the realities of dealing with Recovery Audit Contractors (RACs) more palatable for providers across the country, one of the nation’s top health officials apparently couldn’t help but take a swing at…
Part II continues to explain the nuances in the changes made by CMS to its statistical sampling methodology. The Centers for Medicare & Medicaid Services (CMS) recently made significant changes in its statistical sampling methodology for overpayment estimation. Effective Jan. 2, 2019, CMS radically changed its guidance on the use…
Effective Jan. 2, 2019, the Centers for Medicare & Medicaid Services (CMS) radically changed its guidance on the use of extrapolation in audits by Recovery Audit Contractors (RACs), Medicare Administrative Contractors (MACs), Unified Program Integrity Contractors (UPICs), and the Supplemental Medical Review Contractor (SMRC). Extrapolation is a veritable tsunami in…
The ADR rule went into effect Jan. 1, 2019 The Centers for Medicare & Medicaid Services (CMS) has updated its criteria for additional development requests (ADRs). If your ADR “cycle” is less than 1, CMS will round it up to 1. When a claim is selected for medical review, a…
Although the details of federally ordered auditing of providers have changed over the years, one thing remains the same. We have lived for years under the Sword of Damocles – the continuing waves of healthcare audits by federal contractors. The names of the Medicare Recovery Audit Contractors (RACs) have changed…
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