Tag Archives: cms rac

“Finally Friday!” RAC Actions: Fall 2017

Friday, September 15 2017 RAC Actions: Fall 2017 …Or… WHAT can they do, WHEN can they do it, and HOW? Watch for the Handouts As providers well know, these “killers” can sneak up on you! Finally Friday! Broadcasts are Sponsored … Continue reading

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“Finally Friday!” The Prodigal RAC Returns

FRIDAY February 17, 2017: The Prodigal RAC Returns or Rules? Nah… Rules are so 2016… Watch for the Handouts Finally Friday! Broadcasts are Sponsored by The Health Law Partners, ZirMed, and The American College of Physician Advisors THIS WEEK, we … Continue reading

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Nominee Tom Price Wants Shift Away from Medical Necessity Audits To Anti-Fraud Audits

CMS should focus its billing audits less on verifying medical necessity and more on rooting out blatant fraud, the agency’s likely next secretary said Tuesday. Rep. Tom Price, R-Ga., made statements to that affect while appearing before the Senate Finance … Continue reading

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AHA Offers HHS Solutions to Reduce Medicare Appeals Backlog

The American Hospital Association (AHA) recently advised the Department of Health and Human Services (HHS) to implement three solutions that would significantly reduce the Medicare appeals backlog at the administrative law judge level. Continue reading

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Federal court denies HHS request for delay in Medicare appeals backlog case

A DC federal court trial judge today denied the government’s request to delay further proceedings in a case brought by the AHA and three hospital organizations to compel the Department of Health and Human Services to meet its congressionally mandated dead Continue reading

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“Finally Friday!” The Calm before the Storm

FRIDAY August 19, 2016: “The Calm before the Storm: or Are We In the Eye?“ Coming soon to a hospital near you! Get the Handouts Sponsored by The Health Law Partners, MAS Coding Solutions THIS WEEK, we once again talk … Continue reading

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CMS Temporarily Pauses Two-Midnight Reviews by QIOs

Reasoning Unclear, Time-frame Indeterminate Audits of Medicare claims concerning the Two-Midnight Rule are temporarily suspended by CMS, to allow CMS to collaborate with the two BFCC-QIO contractors, Livanta and KEPRO, “to ensure consistency in how the rule is applied to … Continue reading

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Via: Medicare Proposes to Increase RAC Use

[This article originally published in January 2016] If CMS has its way, RACs may be expanding the scope of their review to Medicare Advantage claims, and it has published a detailed, 58-point work plan to hire a RAC “to identify … Continue reading

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Via: Medicare over-billing big problem in state

Louisiana is No. 1 again. This time the state posted the highest rate of Medicare over-billing in the country. Those providing medical services in the state charged an estimated $1.25 billion more than they should have. U.S. Rep. Garret Graves, … Continue reading

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CMS Cuts RAC Reviews 75%

Drastic Cut in Hospital ADR Limits The Centers for Medicare & Medicaid Services (CMS) is cutting the Recovery Audit Contractors’ (RACs) universe of hospital claims to review, and the number of records they may request from a hospital, by 75% … Continue reading

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