The American Hospital Association (AHA) sent a letter to the Department of Health and Human Services Inspector General Daniel Levinson on October 24, 2012, urging the Office of Inspector General (OIG) to focus on inappropriate claim denials by Recovery Audit Contractors (RACs). The letter stresses that RAC effectiveness needs to…
Articles Posted in Audit
Medicare Audit Improvement Act of 2012 Proposes to More Heavily Regulate Audit Contractors
Representatives Sam Graves (R-MO), Todd Akin (R-MO), Billy Long (R-MO), and Adam Schiff (D-CA) introduced a bill to Congress on October 16, 2012 which proposes to reduce the Medicare contractor audit burden on hospitals. The bill, called the Medicare Audit Improvement Act of 2012 (Act), proposes changes to the ways…
HDI Posts First Pre-Payment Review Issue
The Region D Recovery Audit Contractor (RAC), HealthDataInsights (HDI), has posted a new issue which states that it will begin pre-payment review of medical necessity for MS-DRG 312 (syncope and collapse). The issue is part of the pre-payment review demonstration program, and is the first approved issue posted as part…
CMS to Conduct Special Open Door Forum on Medicare’s Prior Authorization for Power Mobility Devices Demonstration
On Wednesday, the Centers for Medicare & Medicaid Services (CMS) will host a Special Open Door Forum (ODF) to provide healthcare suppliers and providers an opportunity to learn more and ask questions about Medicare’s Prior Authorization for Power Mobility Devices Demonstration Program. CMS’ new demonstration program, which applies to orders…
Ninth Circuit Decides RAC Reopening is Not Subject to Appeal
On September 11, 2012 the United States Court of Appeals for the Ninth Circuit held that a Recovery Audit Contractor’s (RAC’s) initial decision to reopen a claim is not subject to judicial review. The case, Palomar Medical Center v. Sebelius, involved Palomar Medical Center arguing that a RAC has to…
Name Change for Region A RAC
On August 15, 2012 the Recovery Audit Contractor (RAC) for Region A changed its name from Diversified Collection Services (DCS) to Performant Recovery, Inc. According to the website, processes, people, and contact information will remain the same. If you have questions about Recovery Audit Contractors, or need assistance defending a…
CMS Releases Follow-Up Comparative Billing Reports for Podiatry Services
On September 12, 2012, the Centers for Medicare and Medicaid Services (CMS) released a national provider Comparative Billing Report (CBR) targeting podiatry services. The CBRs will be released to a maximum of 5,000 podiatry service providers. This is the second time in which podiatry services have been the focal point…
AHA Survey Shows RAC Denials Up in 2nd Quarter
On August 22, 2012 the American Hospital Association (AHA) published the results of a survey which indicates that Recovery Audit Contractor (RAC) claim denials were up in the second quarter of 2012 from the first quarter. The results of the survey include data collected from more than 2,000 hospitals nationwide.…
Congressman Urges Investigation Into Connolly
In a press release on August 15, 2012 Congressman Dan Boren, who represents Oklahoma’s second Congressional District, announced that letters have been sent to Secretary of Health and Human Services, Kathleen Sebelius; U.S. Congressman Dave Camp, Chairman of the House Ways and Means Committee; and U.S. Congressman Fred Upton, Chairman…
Ohio Providers May Be Subject to Double Audit Under Demonstration Program
On August 9, 2012, CGS, the MAC for J15, announced that it will begin complex medical review MS-DRG 312, syncope and collapse, based on findings that the claim denial rate for MS-DRG 312 during a probe conducted in Ohio was 79.9%. This means that providers in Ohio could see MS-DRG…