Posts tagged ‘rac’

November 7, 2012

Proposed legislation could put financial penalties on RACs

HealthLeaders is following some legislation introduced a few weeks ago in the U.S. House:

Healthcare recovery auditors (RACs) could face a potential financial penalty for every judgment against a provider that is overturned if a pending bill gets signed into law, according to HealthLeaders Media.

Currently, 75 percent of RAC judgments against providers get overturned when they are appealed, mostly at the administrative law level, where a federal judge is making a decision, according to the American Hospital Association Survey.

Read more at HealthLeaders.

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August 16, 2012

Open Door Forum transcripts now available

There was a delay on the blog post regarding the recent Medicare Open Door Forums … the post didn’t publish until after the forums had happened!
No problem. Transcripts and audio are now available.

From the August 9, 2012 Medicare Fee-For-Service Recovery Auditor Prepayment Review Demonstration Special Open Door Forum.

From the August 7, 2012 Manual Medical Review of Therapy Claims Special Open Door Forum.

June 12, 2012

Connolly issues automatic edit for RAP with no CMS Issue Number

The Centers for Medicare & Medicaid Services (CMS) Recovery Audit Contractor (RAC) Connolly recently issued a new RAC issue: RAP claim without corresponding home health claim CMS Issue Number.

The National Association for Home Care & Hospice (NAHC) has requested clarification from CMS about the basis for this since home health Requests for Anticipated Payment (RAP) are supposed to be automatically recovered through the Medicare claims processing system when a home health agency fails to submit a final claim within a certain time period (120 days or 60 days of the RAP payment).

Connolly is the RAC for Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands, Virginia, and West Virginia.

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February 8, 2012

RAC demonstration reviews begin after June 1

After a six-month delay, CMS just announced that the Recovery Audit Prepayment Review will move forward after June 1.

The review (a demonstration project) will allow Medicare Recovery Auditors (RACs) to review claims before they are paid to ensure that the provider complied with all Medicare payment rules. The RACs will conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments.

The demonstration is part of CMS’s crackdown on waste and fraud.

The reviews will focus on seven states with high populations of fraud- and error-prone providers (FL, CA, MI, TX, NY, LA, IL) and four states with high claims volumes of short inpatient hospital stays (PA, OH, NC, MO).

January 25, 2012

RAC focus revealed in quarterly newsletter

This recent release by CMS does NOT include home health data, but it does give an idea of what disease systems they see troubles with, as well as what they are looking at in other provider areas.

I’ll link you to the archive of the agency’s quarterly compliance newsletter so you can review all of them, if you like.