The Centers for Medicare & Medicaid Services (CMS) has taken the next steps in the agency’s comprehensive efforts to identify improper Medicare payments and fight fraud, waste and abuse in the Medicare program by awarding contracts to four permanent Recovery Audit Contractors (RACs) designed to guard the Medicare Trust Fund.
By Jennifer Lubell | August 16, 2010
| Print Magazine
Healthcare experts are questioning whether outside auditors for the Medicare program are prepared to take on a new type of advanced audit that addresses a touchy and personal subject: the necessity of a patient's care.
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President Barack Obama is expected to sign a bill into law Thursday that aims to reduce improper federal payments, paving the way for more recovery audit contractor-type programs beyond Medicare.
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By Jennifer Lubell | July 19, 2010
| Print Magazine
As the federal government gears up for a major expansion of a controversial audit program, industry experts are skeptical that the CMS will have the resources to pull this off by the end of the year.
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The CMS faces some challenges ahead in expanding the Recovery Audit Contractor program to all of Medicare and to Medicaid by the end of year, an agency representative told a Senate panel.
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Recovery audit contractors denied $2.47 million in Medicare claims to 437 hospitals in the first quarter of 2010, the American Hospital Association announced.
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The CMS has awarded a five-year contract totaling $304.5 million to Palmetto GBA, Columbia, S.C., to administer Part A and Part B Medicare fee-for-service claims under the Medicare Administrative Contractor program.
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Medicare contractors responsible for finding fraud and recovering overpayments have lackluster and uneven track records, according to two new reports by HHS' inspector general's office.
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The CMS has made progress implementing Medicare contracting reforms, but certain decisions have led to payment delays to providers, the Government Accountability Office concluded in a new report.
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By Jennifer Lubell | April 19, 2010
| Print Magazine
A recent federal report underscores the need for hospitals and the CMS to step it up in preventing the most significant types of errors identified by the Recovery Audit Contractor program, industry experts say.
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The CMS needs to do a better job of addressing and promptly correcting service-specific errors that result in improper payments under its Recovery Audit Contractor program, the Government Accountability Office recommended in a new report.
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By Jennifer Lubell | March 15, 2010
| Print Magazine
An edict from the White House to expand fraud and abuse audits on a governmentwide basis puts the heat on hospitals to keep their shops in order and free of error, some industry experts claim.
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President Barack Obama plans to announce an expansion of payment recapture audits to fight waste and abuse in Medicare, Medicaid and other government programs.
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By Jennifer Lubell | February 22, 2010
| Basic Web
Recovery audit contractors should receive mandatory training on the identification and referral of fraud, HHS' Office of the Inspector General recommended in a new report.
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Recovery audit contractors are going to get a lot more personal in their audits of hospital providers this year, and the industry could see further reductions in their inpatient payments to accommodate a new federal documentation and coding system.
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By Jennifer Lubell | December 21, 2009
| Basic Web
With auditors beginning the process of conducting more advanced audits in CMS' Recovery Audit Contractor program, some industry experts speculate that RACs will try to sniff out evidence of “upcoding.”
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By Jennifer Lubell | November 30, 2009
| Basic Web
A provision to extend a controversial federal audit program beyond Medicare fee-for-service remained in the final Senate healthcare reform package. Some providers are wondering if such an expansion is really necessary.
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A controversial audit program in the process of being rolled out in all 50 states by 2010 is sparking concerns not just from the nation's largest hospitals, but the smallest physician practices as well. The Recovery Audit Contractor, or RAC, program was created by the Medicare Modernization Act of...
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By Matthew DoBias | September 24, 2009
| Basic Web
States would have up to one year to repay the federal government a share of the money they recoup from fraudulent or improper Medicaid payments, under an amendment approved by the Senate Finance Committee.
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By Jennifer Lubell | September 21, 2009
| Basic Web
Hospitals and others in the healthcare industry are expressing trepidation over a provision in the newly released Senate Finance Committee reform bill to expand a controversial Medicare audit program.
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State licensing authorities might question whether recovery audit contractors' determining whether particular services are medically necessary is in fact “practicing medicine.”
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The government does not recognize that there is an inherent under-documentation problem, which leads to under-coding and under-billing. Doctors are not trained to document accurately and completely in medical school. Their primary focus is patient care.
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There is a critical issue that hospitals are having with these contractors. The organizations that are selected by the government for Medicare's Recovery Audit Contractor program and the Medicaid Integrity Contractor program lack the technology to support the process.
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After reading the article “One-day stays a big reason for excess pay to hospitals, RAC project finds,” if I were a consumer of services, I would want to know specifically the criterion for determining either hospital admission or outpatient procedure determination.
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Carriers are picking on one or two claims pertaining to down-coding of medically necessary office visits. It costs the provider more to fight one claim of $120 but the physician feels obligated to do this to protect his integrity of coding.
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If the answer is transparency, the germane and honest question is “for whom?” The revised Pharmaceutical Research and Manufacturers of America code (along with recent announcements by Eli Lilly and Co., Merck & Co. and others that they will make public their financial relationships with...
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The concept here is good, however, the CMS has failed miserably in placing proper oversight on these contractors. While the existing contractors have made significant gains in recovery, they are also responsible for a significant increase in the appeals from doctors who feel that the decisions are...
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