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A colleague of ours, here at RACmonitor, a colleague whose modesty keeps us from revealing his identity, is a straight shooter and for good reason: he served his country as an officer in the US Army. And he's also an Eagle Scout.
While a number of us...
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ED. NOTE: RACmonitor continues with its ongoing coverage of the 72 Hour Rule as it makes its way through the legislative process. You will find the most recent updates at racmonitor.com. Here is the latest in a continuing series on the 72 Hour Rule fr...
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The primary goal for CMS must be to ensure that corrective actions are in place so that improper payments can be reduced, says GAO.
What are the Centers for Medicare & Medicaid Services (CMS) doing to ensure quality in the recovery audit contra...
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Virginia, West Virginia Also Added
Connolly Healthcare, the RAC for Region C, posted 20 new DRG Validation Issues to their list of CMS-Approved audit issues, on Friday, April16. The new issues include eight (8) MS-DRGs with very high Relative We...
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If there was ever a time to have your physicians download RACmonitorEnews, this Thursday's edition is probably your best bet as well as a smart strategy to secure physician buy-in for the RAC preparedness work you're doing.
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More High Volume, High Dollar Value DRGs
The Region C RAC, Connolly Healthcare, posted 25 new DRG Validation Issues to their list of CMS-Approved audit issues, on Tuesday, March 16 plus another five (5) on Friday, March 19. Once again, Connolly...
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Connolly Consulting Associates, the recovery audit contractor (RAC) for Region C, recently added another 25 MS-DRG validations to its approved list of issues. This brings its total to 104 MS-DRGs. Of the newly released MS-DRGs, 22 out of the 25 are surgic...
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The week of March 15 - the ides of March - is when, in a nanosecond, Marcus Junius Brutus and others stabbed the Emperor Julius Caesar to death in the Roman Senate in 44 B.C. Were it not for the soothsayer who previously had warned Caesar to "beware the i...
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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.
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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...
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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 a...
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The recent announcement by CMS regarding its modification of additional documentation requests for institutional providers during fiscal year 2010 has generated considerable response from providers seeking clarification about tax identification numbers an...
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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...
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Providers in Florida have gotten used to all the jokes about our fine state, and in particular the one about the city of Miami being the epicenter, or ground zero, of Medicare fraud (cue up "Conga" with Gloria Estefan and the Miami Sound Machine).
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We all know that the RACs are here, but what should we be doing to be in the best position to minimize the stress that their audits could cause?
To answer that question, I spoke with Ted Anderson, FHFMA, CPA, who is the Controller for Highlands Regional ...
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Critical Access Hospitals (CAHs) are different - well, at least for Medicare.
Prospective payment systems like APCs and MS-DRGs are not used by CAHs. So does this mean that the RACs will not be interested in CAHs?
With a moment's reflection you will pro...
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We heard recently that the RACs submitted over 90 issues for CMS aproval, to begin their audits of provider claims going back to October 1, 2007. Before a RAC can officially conduct an audit for any issue, they must have it approved by CMS, and the is...
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By: George L. Kelley, MS, MBA
In preparing your facility for RAC reviews, our organization has supported and championed a data mining approach that will identify specific cases at risk for review by the RACs. Once these cases are identified, they n...
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This time last year, in the first RACMonitor edition, I discussed the potential rollout of the RAC recoupment process on a regional and state-specific basis. As we all are well aware, the original rollout plans never came to fruition, but I would venture ...
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In this era of reducing improper healthcare payments, providers obviously are gearing up for some major league defense against the RACs, ZPIC, MICs and other governmental auditing bodies by shoring up their coding and billing practices. But there also hav...
