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.
Various Medicare and Medicaid auditing initiatives have sharply lowered erroneous excess payments under the programs over the past three years, according to the... FULL STORY »
HMS Holdings Corp., a New York-based benefits coordinator for payers, has signed a definitive agreement to acquire privately held HealthDataInsights, Las Vegas, a recovery... FULL STORY »
By Melanie Evans | October 10, 2011
| Print Magazine
Audits that have turned up more than $680 million so far in Medicare payment errors started slowly in the first year, a new report shows. More recent data suggest auditors have grown more aggressive as the program prepares to expand. FULL STORY »
By Rich Daly | September 19, 2011
| Print Magazine
Hospitals fear Medicaid's new audit program could mean multiple examinations of the same issues from different reviewers, as well as more reviews of the medical necessity of hospital care. FULL STORY »
By Jessica Zigmond | September 14, 2011
| Basic Web
Building on the Medicare Recovery Audit Contractor program, HHS on Wednesday issued a final rule to establish a Medicaid Recovery Audit Contractor program that the agency expects will save $2.1 billion in waste over the next five years. FULL STORY »
The CMS' Medicare fee-for-service recovery audit contractor program collected about $233.4 million in overpayments from March through June of this year, bringing the total of recouped overpayments since October 2009 to about $575.2 million. FULL STORY »
By Jessica Zigmond | May 02, 2011
| Print Magazine
The American Hospital Association said last week that it is pleased the CMS has released data on what it has recouped in improper Medicare payments, but would still like to see information about the appeals process in the agency's recovery audit contractor program. FULL STORY »
By Christine LaFave Grace | April 26, 2011
| Basic Web
The CMS has collected more than $313 million in Medicare overpayments through its recovery audit program since October 2009, according to the CMS' most recent recovery-audit report—and nearly half of that was collected from January through March of this year. FULL STORY »
By Jessica Zigmond | November 05, 2010
| Basic Web
In a proposed rule regarding new Medicaid recovery audit contractors, the CMS said states will be allowed to determine whether to pay their Medicaid RACs on a contingency basis or under some other fee structure that identifies underpayments. FULL STORY »
Senate Finance Committee ranking member Chuck Grassley (R-Iowa) has asked the CMS to list any identified conflicts of interest among the agency's contractors and highlight any steps that CMS has taken to prevent those conflicts. FULL STORY »
The CMS probably paid more than $8 million between 2006 and 2007 for healthcare services rendered after the patients' deaths, a federal audit has found. FULL STORY »
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. FULL STORY »
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. FULL STORY »
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. FULL STORY »
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. FULL STORY »
Recovery audit contractors denied $2.47 million in Medicare claims to 437 hospitals in the first quarter of 2010, the American Hospital Association announced. FULL STORY »
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. FULL STORY »
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. FULL STORY »
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. FULL STORY »
My question is, how much of the recovery included simple coding mistakes—i.e. duplicate lines etc.—that the financial intermediary could have and should have caught? FULL STORY »
It will be interesting to see how this one works out. Most recovery audit contractors are selected via lowest-priced bids. Fees paid to RACs are very low; waiting for payment may cause budget issues for RACs. FULL STORY »
State licensing authorities might question whether recovery audit contractors' determining whether particular services are medically necessary is in fact “practicing medicine.” FULL STORY »
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 »
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 »
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 »
