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Although the Centers for Medicare & Medicaid Services (CMS) does not mandate areas for Recovery Audit Contractors (RAC) to review, it does "share" information with them and "encourage" them to consider non-RAC audit findings in making decisions about issues of concern. Read more
By Frank Sheeder, Esq. and Lindsey Bartula, Esq. Responding to RAC reviews by focusing on coding and medical necessity is not enough; it leaves some good arguments on the table. Read more
The file drawer that I have dedicated to interpretations, congressional maneuvering, laws thwarted, laws passed, CMS clarifications and CMS instructions related to the 3-day Payment Window is overflowing like Snooki Polizzi in a leopard-print mini dress. Read more
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This Week's Top Stories are sponsored by: Panacea Healthcare Solutions, LLC.
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Beware: RACs to Apply New Signature RequirementsAmy K. Fehn, Esq. | Thursday, 19 August 2010 By Amy K. Fehn, Esq. and Jennifer Colagiovanni, Esq. One way providers can avoid Medicare audit denials is to be aware of, and in compliance with, CMS's recently updated signature guidelines. Contractors engaged in medical review activities are instructed to apply the new signature requirements for... Read More... |
RACs, QIOs Seen as Developing Innovative Denial StrategiesPaul Weygandt, MD, JD, MPH, MBA, CPE | Thursday, 19 August 2010 On March 10, President Obama issued an executive memorandum to the heads of federal executive departments and agencies, directing them to "expand their use of Payment Recapture Audits, to the extent permitted by law and where cost-effective." "Payment Recapture Audits," a newly coined term, refers to the efforts of... Read More... |
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Top DRGs Approved for RAC Medical Necessity Review: But What’s New?Ernie De Los Santos | Thursday, 19 August 2010 CGI Federal, the CMS Recovery Audit Contractor (RAC) contracted for reviews of Medicare claims in seven states, posted approvals for the review of both Medical Necessity and DRG Validation for new and updated issues including 29 DRGs since Aug. 12. Of the 29 DRGs half are among the top 20... Read More... |
RACs Deny $2.47 Million in Medicare Claims in First QuarterFrank Sheeder, Esq. | Thursday, 22 July 2010 By: Frank Sheeder, Esq. and Lindsey F. Bartula, Esq. There are some recent reports that quantify RAC activity for the first part of 2010. Results from the American Hospital Association's (AHA's) April 2010 RACTrac Survey indicate that for 653 responding hospitals, RACs denied a total of $2.47 million in... Read More... |
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Connolly Healthcare posted 29 DRGs for review of medical necessity on Friday, August 27 and edited some posts on their website today, leaving some MSDRGs posted in multiple issues, some of which are contradictory. An example is MSDRG 314, which as of 4:00pm ET appears in three different issues posted:
EDITOR'S NOTE: Lest we forget, at about 8 a.m. on what would be a fateful Thursday, Sept. 1, 2005, with thousands of flood victims beginning to fill the Superdome, Children's Hospital President and CEO Steve Worley turned out the lights at his facility, closing it for the first time in its 50-year history. Brian T. Landry, vice president of marketing for Children's Hospital, was there, and he reports for RACMonitorEnews then and now in his own words.
Although Recovery Audit Contractors (RACs) are not currently evaluating facility evaluation and management (E&M) services, it may not be long before they do.