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 Gregg Blesch |
March 10, 2010
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Basic Web Registration President Barack Obama plans to announce an expansion of payment recapture audits to fight waste and abuse in Medicare, Medicaid and other government programs. FULL STORY »
By Jennifer Lubell |
February 22, 2010
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Basic Web Registration 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. FULL STORY »
January 11, 2010
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Print Magazine Subscription 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. FULL STORY »
By Jennifer Lubell |
December 21, 2009
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Basic Web Registration 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.” FULL STORY »
By Jennifer Lubell |
November 30, 2009
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Basic Web Registration 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. FULL STORY »
November 13, 2009
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Free Access 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... FULL STORY »
By Matthew DoBias |
September 24, 2009
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Basic Web Registration 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. FULL STORY »
By Jennifer Lubell |
September 21, 2009
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Basic Web Registration 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. FULL STORY »
By Jennifer Lubell |
August 10, 2009
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Basic Web Registration IPRO, a quality improvement and evaluation organization in Lake Success, N.Y., has been awarded a contract to audit claims and identify potential overpayments under the CMS' Medicaid Integrity Program. FULL STORY »
By Jennifer Lubell |
August 06, 2009
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Basic Web Registration Medicare's Recovery Audit Contractor in CMS Region C has posted the first set of issues eligible for audit for outpatient hospital and physician providers in South Carolina, possibly setting a precedent for other RAC audits across the country. FULL STORY »
By Melanie Evans |
July 31, 2009
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Basic Web Registration Medicare's three-year pilot project to audit hospital, physician and other provider payments found that CMS overpaid for care by more than $980 million, thanks largely to poor records, billing errors and medically unnecessary care. One of the most frequently cited reason for excess pay to... FULL STORY »
June 17, 2009
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Free Access Modern Healthcare reporter Melanie Evans talks with Rudy Braccili Jr., director of the national Medicare and Medicaid center for Tenet Healthcare Corp. subsidiary Conifer Health Solutions, about the Recovery Audit Contractor program during the Healthcare Financial Management Association's... FULL STORY »
By Jennifer Lubell |
June 15, 2009
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Print Magazine Subscription The CMS is attempting to clarify the role of new federal contract audits being performed under Medicaid that providers fear will operate in a similar fashion to the controversial Recovery Audit Contractor program in Medicare. FULL STORY »
By Jennifer Lubell |
June 01, 2009
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Basic Web Registration It may be the calm before the storm for providers subject to the Recovery Audit Contractor program. As soon as this week, the first audit letters requesting medical records of hospitals are expected to be sent out to hospitals under the new program. FULL STORY »
By Jennifer Lubell |
May 15, 2009
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Basic Web Registration PRG-Schultz International, Atlanta, a subcontractor in the CMS’ Recovery Audit Contractor program, has announced that its treasurer and chief financial officer, Peter Limeri, will be resigning on May 31. FULL STORY »
By Jennifer Lubell |
May 04, 2009
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Print Magazine Subscription The American Hospital Association has developed a new tool that seeks to bulk up its lobbying power in proposing any changes to Medicare’s controversial Recovery Audit Contractor, or RAC, program. FULL STORY »
By Jennifer Lubell |
April 23, 2009
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Basic Web Registration The American Hospital Association has released an advisory to members on Medicare’s Recovery Audit Contractor program discussing the contingency fee percentages that will be paid to each contractor. FULL STORY »
By Jennifer Lubell |
March 27, 2009
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Basic Web Registration A San Diego health system has filed a complaint in federal court, challenging procedures used by Medicare’s recovery audit contractors to reopen claims. The suit, filed by two-hospital Palomar Pomerado Health against HHS, alleges that RAC contractor PRG-Schultz International unlawfully reopened a... FULL STORY »
By Jennifer Lubell |
March 09, 2009
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Basic Web Registration The Recovery Audit Contractor, or RAC, program, has caused a great deal of controversy, yet the CMS wants to make its new audit process “a fair program” for providers, said Lt. Terrence Lew, a health insurance specialist with the CMS’ Division of Recovery Audit Operations’ Financial Services Group,... FULL STORY »
By Jennifer Lubell |
March 09, 2009
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Print Magazine Subscription A perfect storm of administrative woes has been brewing over physicians’ offices in sunny California. FULL STORY »
February 13, 2009
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Basic Web Registration Read CMS' "Medicare Recovery Audit Contractor program: An Evaluation of the 3-Year Demonstration." FULL STORY »
December 09, 2009
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Basic Web Registration 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. FULL STORY »
December 02, 2009
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Basic Web Registration 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. FULL STORY »
August 11, 2009
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Basic Web Registration 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. FULL STORY »
May 07, 2009
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Basic Web Registration 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. FULL STORY »
November 10, 2008
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Print Magazine Subscription 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... FULL STORY »
October 13, 2008
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Basic Web Registration 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... FULL STORY »
