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In January CMS posted two new questions and answers on its FAQ Web site: numbers 9973 and 9974. Both of these relate to hospital outpatient observation services, which has been a problem area for two decades. Read more
U.S. ambulance providers generated about $9 billion in revenue in 2009, according to information gathered by Hoover's, Inc., which offers proprietary business information through the Internet and other online services. Of that amount, hospital-based ambulance services commanded a 9 percent market share. Not surprisingly, given the Medicare program's complex billing requirements, ambulance services were one of the approved audit issues listed by the RACs in early January 2010. Read more
Little did I know when I e-mailed one of the authors of a Feb. 3 article in RACMonitor (Is It Worth the Effort to Rebut RAC Findings: 10 Steps for a RAC Discussion) that my comment would turn into a discussion and now an article of my own on the differences between the discussion and rebuttal processes. Read more
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When to Call in the Big Guns: RAC Preparedness and OutsourcingCarla Engle, MBA | Wednesday, 3 February 2010 Okay, you've followed all the advice and you're prepared for the RACs, the ZPICs, the MACs, the MICs. You've created a RAC team, drafted policies and procedures, done trial work flow processes, and sat in on who-knows-how-many webinars and conferences on how to prepare for governmental audits. Read More... |
Why Medicare Advantage (Part C) Denials Should Be On Your RAC/Medicare Team ProtocolLinda Fotheringill, Esq. | Wednesday, 20 January 2010 I have always recommended the "RAC" team concept to be expanded to include al Medicare denials such as those generated by other claim review programs (i.e., MAC Pre & Post payment reviews, CERT, NCCI, MUE, ZPIC, etc.) Read More... |
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Important: Newest PEPPER Data Now Available for HospitalsBarbara Vandegrift, RN, BSN, MA | TUSEDAY, 16 February 2010 There's a new PEPPER report, and those who know that the acronym isn't just an all-around-useful kitchen spice can now go to My Quality Net to obtain a copy. The first 2010 release was scheduled to post on January 25 and finally made it on February 5. So, the files... Read More... |
Trend for High Dollar Claims Continues as Connolly Posts 19 New DRG Validation IssuesErnie De Los Santos | Wednesday, 10 February 2010 Connolly Healthcare, the RAC for Region C, has posted 19 new approved issues for Complex Review on their RAC Issues page. The new issues were posted on Monday, February 8, 2010. The listed issues include only single MS-DRGs, but are still not listed in any discernable order. All of the... Read More... |
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Get free downloads for Internet Explorer 7, including recommended updates as they become available. To download Internet Explorer 7 in the language of your choice, please visit the Internet Explorer 7 worldwide page.
We all suspected it, but now it's official: RACs will be providing information to CMS for follow-up on cases of possible fraud. In February, Inspector General Daniel Levinson issued a report titled "Recovery Audit Contractors' Fraud Referrals." The report provides a review of demonstration RAC activity and subsequent recommendations from the Inspector General's office regarding RAC referrals of potential fraud cases.
Clinical and administrative staff at many organizations are struggling with the issue of what "medically necessary" really means - even those who have reviewed the Medicare Benefit Policy Manual (MBPM), Chapter 8, section 20.1 
Now that the RAC audits are in full swing, providers may be wrestling to understand the new discussion period and the implications for choosing to exercise this new option and when they should actually consider initiating a discussion period.
