The Centers for Medicare and Medicaid Services (CMS) issued a new transmittal to address concerns regarding the reporting of recoupment for overpayment on the remittance advice (RA). During the RAC demonstration project providers would receive an RA, which is a notice of payments and adjustments sent by Medicare contractors to…
The RAC for Region C, Connolly Healthcare, has added 20 new DRG Validation issues to the list of CMS-approved audit issues. In addition, earlier this month several issues were approved for Region C providers in Virginia and West Virginia. If you need assistance with a RAC or third party payor…
Providers and suppliers that receive request letters from Recovery Audit Contractors (RACs) should ensure the following: The claims selected involve issues approved for review on their RAC region’s approved issues list. The request letters meet the timeframes and medical record limits set by CMS. The particular claims at issue have…
In a decision issued February 10, 2010, the Medicare Appeals Council reached a decision on an appeal from the RAC Demonstration Project. The Recovery Audit Contractor (RAC) initially found that the provider had received an overpayment for the inpatient services covered under Medicare Part A, but the beneficiary met the…
Region A: The RAC for Region A, DCS Healthcare, posted three new issues for non-medical necessity DRG validation inpatient claims review for providers in District of Columbia, Connecticut, Massachusetts, Maine, Delaware, New Jersey, New York, New Hampshire, Pennsylvania, Rhode Island, and Vermont. Region B: Region B’s RAC, CGI, added 20…
The Patient Protection and Affordable Care Act passed signed into law by President Obama impacts providers in several ways. One of the areas of impact to providers is the expansion of the Recovery Audit Contractor (RAC) Program. The Act expands the RAC Program to Medicaid by requiring that each state…
February 22, 2010: In a report released last week, CMS revealed that Recovery Audit Contractors (RACs) referred two cases of potential fraud to the Department of Health and Human Services Office of Inspector General (OIG) during the RAC Demonstration Program between March 2005 and March 2008. The published report states…
On January 28, 2010, the Centers for Medicare and Medicaid Services (CMS) announced modified additional documentation request limits for institutional providers for the RAC program in FY 2010. The limits will be annually set by each RAC in accordance with this CMS guidance to create a per campus cap on…
The RAC for Region D, HealthDataInsights (HDI), recently approved “anesthesia care package” and evaluation and management services for RAC review. Specifically, HDI stated: Under NCCI Edit rules, the anesthesia care package consists of preoperative evaluation, standard preparation and monitoring services, administration of anesthesia, and post-anesthesia recovery care. Anesthesia CPT codes…