Tag Archives: recovery audit contractor

“Finally Friday!” Solutions to RAC ADRs, Global Settlement Offer

FRIDAY September 26, 2014 Solutions to Recent CMS Initiatives How Some Providers Address Them Get the Handouts One thing’s for sure… it’s not boring around here, is it? This week we’ll cover two key subjects and the re-appearance of RAC … Continue reading

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CMS Report Reveals 77% of Appealed RAC Denials Are Improper

Figures Show 55% of RAC Denials Are Improper If you read my previous article and then read the CMS Report to Congress for the RAC Program in FY2013, you can find figures that tell the story in the title of … Continue reading

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Many Changes Posted in CMS Global Settlement Offer FAQs

CMS posted many changes to their Frequently Asked Questions (FAQ) documents about their recently issued proposed settlement terms – demanding an “all in” stance – for acute care hospitals with appeals stuck in the highly over-burdened Medicare appeals process, on August … Continue reading

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“Finally Friday!” Final Word on Transmittal 541 and “Clawbacks”

FRIDAY September 19, 2014 The Final Word on “Clawbacks” Transmittal 505/534/540/541 Watch the Replay and Get the Handouts Project FAIL: when a government project fails, they just change it’s mission – reset the parameters, the expectations. That’s what happened with … Continue reading

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New CMS RAC Contract Awards Blocked by Federal Court

The U.S. Court of Federal Claims blocked the Centers for Medicare and Medicaid Services (CMS) from awarding new Recovery Audit Contractor (RAC) contracts pending a court appeal filed on August 22, 2014, by CGI Federal (CGI), one of the prospective … Continue reading

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“Finally Friday!” CMS OMHA Settlement Conferences and Statistical Sampling

OMHA Settlement Conferences and OMHA Statistical Sampling Alternate but Rejected Title for this Show: How CMS Plans to Use Your Money to Solve Their Problems We were joined this week by Jessica Gustafson and Abby Pendleton from The Health Law … Continue reading

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“Finally Friday!” MAC Probes, AHA Lawsuits, and OIG Reports on E/M

Bill Malm of Craneware reviews some new OIG Reports, foreshadowing perhaps a flood of E/M Audits by CMS contractors. We also hear from Dr. Ron Hirsch of Accretive PAS about some of the insanity coming out of the MACs in Probe and Educate. Jessica Gustafson and Abby Pendleton from The Health Law Partners give us some legal perspective on the OIG postings, and a short review of the recent AHA filing of a mandamus complaint – a filing seeking a judicial remedy to require CMS to “meet statutory deadlines for administrative review of denials” for Medicare claims. Continue reading

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News from the Week of February 28

The Pause Expands Last Month, CMS extended the pause (I refuse to call it a moratorium) on RAC reviews of Medicare claims under the  2 Midnight Rule to a full year, from Oct. 1, 2013 to Sept. 30, 2014. MACs, … Continue reading

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News & Opinion from the Week of November 3 – 9, 2013

AHA and AMA to CMS Re: Two-midnight Policy Inpatient Admission and Review Criteria The AHA and the AMA issued a joint letter to CMS Administrator Marilyn Tavenner on Friday, January 8, in a rare show of combined agreement and support … Continue reading

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“Finally Friday!” 2014 IPPS Final Rule for Dummies – Part 2

This session was recorded on Friday, September 20, 2013.   Certification Forms & Decision Trees We covered two topics this week, relative to the 2014 IPPS Final Rule, concerning Certification requirements and a set of Decision Trees we have created … Continue reading

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