Should providers who play by the Medicare payment rules be granted “most-favored nation” status, as U.S. Sen. Max Baucus, D-Montana, seemed to indicate during a recent hearing of the Senate Finance Committee focusing on the RACs?  In a report to investors, Emily Evans used the phrase “most-favored nation” to describe Baucus’ approach, which would involve incentivizing the RACs to focus on what he described as the “most at-risk services and providers” while rewarding providers with a “long track record of following the rules.”
Evans will be reporting on the hearing during the first portion of a special two-part Monitor Monday series begins today on Monitor Monday. During Part I we’ll explore the current RAC environment, seeking to determine if such a designation is appropriate.
One of the witnesses during the Senate hearing, Jenifer J. Carmody, director of reimbursement services for Billings Clinic in Billings, Mont., will be our special guest. Joining the discussion will be Kathyrn Miller, compliance officer and RAC coordinator for North Adams Regional Hospital in North Adams, Mass. Miller, told RACmonitor that her facility had 184 charts audited by the RAC with 84 percent having no findings.
Also on the broadcast will be healthcare attorney Andrew Wachler, who has worked with the CMS to obtain meaningful relief from the agency’s current policies on providers obtaining Part B payment when Part A services are denied as not medical necessary or provided in the wrong setting.

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