Know Your Opponents

Patricia Dear, president and CEO of eduTrax, goes into considerable detail in forewarning you of the expertise RACs bring to data mining and claims analysis. Are you prepared, asks Dear, not so rhetorically? These companies are experts. Who are yours?


Is Extrapolation Being Used on You by RACs?

Cheryl E. Servais, MPH, RHIA, and vice president compliancy and privacy officer at Precyse, reports that you may not know that the RAC has used exploration in reviewing your claims until after the fact, when the demand letter arrives. Can you appeal? Servais explains all.


Minimizing Risk

We welcome guest contributing editor Jeanine M. Tome, RNC, MSN, ACM, CHPQ, and the chief clinical officer for Allscripts Care Management. In her article, “The Curious Case of the RACs,” Tome offers 13 steps that your internal RAC and care management teams can take to minimize risks and prevent takebacks.


Get Ready for the MICs – the RAC-like Medicaid Contractors

“As if we don’t have enough on our plates with the RAC Medicare Program, our Medicaid revenue undoubtedly soon will be subjected to similar harsh scrutiny,” reports Linda Fotheringill, Esq. and founding member of Washington West, LLC. Fotheringill will provide you with a chilling overview of the MICs in this Thursday’s RACMonitorEnews. Says Fothergill, “Please understand that as a taxpayer, I certainly am opposed to ‘fraud & abuse,’ however, in my personal experience evaluating and successfully appealing many hundreds of claims denied by the RACs for alleged lack of medical necessity, I know that CMS reports of ‘overpayments’ are misleading.”


Talk About Fraud and Abuse

Busting healthcare crime in South Florida is vividly outlined in this Thursday’s RACMonitor Enews by Nancy J. Beckley, MS, MBA, CHC, who reports on the activities of the South Florida Medicare Strike Force as presented in last week’s presentation at HCCA in Las Vegas.

So be sure to check out this Thursday’s RACMonitor Enews – the single most important source of RAC news and information.