The Centers for Medicare & Medicaid Services (CMS) intends to reduce the Comprehensive Error Rate Testing (CERT) error rate by correcting vulnerabilities identified by Recovery Auditors and other Medicare contractors during DRG Validation reviews. DRG Validation review focuses on the hospital’s selection of principal and secondary diagnoses and procedures on…
The Centers for Medicare and Medicaid Services (“CMS”) are using Comparative Billing Reports as a tool to educate providers about their individual billing practices. Comparative Billing Reports (“CBRs”) show individual providers how their billing patterns for various codes and procedures compare to the state average and the national average for…
DCS Healthcare added 11 new approved issues for medical necessity reviews for providers in Region A states. The recently approved new issues may be reviewed for providers in Pennsylvania, the District of Columbia, New Jersey, Delaware, New York, Connecticut, Vermont, Maine, Massachusetts, New Hampshire, and Rhode Island, excluding Maryland. The…
On June 1, 2011, the Office of Inspector General (OIG) announced that it expects to recover an estimated $3.4 billion in connection with its Medicare and Medicaid investigations, audits, and reviews. The amount was accrued between October 2010 and March 2011 in the form of penalties, fines, and settlements. Of…
The Centers for Medicare & Medicaid Services (CMS) intends to roll out its Part D RAC program during the third quarter of 2011. In implementing the program, CMS has contracted with ACLR Strategic Business Solutions to be the Part D recovery audit contractor. This company has already recovered tens of…
Over $365 Million in Improper Payments Identified By RACs Since October 2009 CMS recently reported that RACs have identified $312.2 million in overpayments from October 2009 through March 2011. During the same period, $52.6 million in underpayments were identified. While these figures are well below the over $1 billion in…
DCS Healthcare: The Region A RAC added three new medical necessity claims to its approved issues list. These claims are: Peripheral/cranial nerve and other nervous system procedures with MCC (MS-DRG 040); ECMO or tracheostomy with MV 96+ hrs or PDX except face, mouth and neck with major O.R. (MS-DRG 003);…
Recovery Audit Contractors (RAC) recovered $237.8 million in the six-month period that ended in March. This amount is already three times more than the amount of money recovered in the previous year. According to recent estimates, CMS alleges that the total sum of Medicare improper payments exceeds $47 billion annually.…
CGI, the Recovery Audit Contractor (RAC) for Region B, recently removed four DRG validation issues from its list. This means that providers in Region B will no longer be subject to RAC audits on these particular procedures. Connolly has added several new RAC issues to its CMS approved list. One…
Effective February 14, 2011, CMS has limited the number of records RACs may request when reviewing Medicare claims from Physicians and other practitioners. These requests for medical records, which are used in connection with complex claims reviews, will be limited based on the size of the group/office being audited. If…