The Centers for Medicare and Medicaid Services (CMS) published a proposed rule on November 5 regarding RAC activities for Medicaid programs. Section 6411 of the Patient Protection and Affordable Care Act (PPACA) requires states to contract with one or more Medicaid RACs by December 31, 2010. By that date, states…
The RACs for Regions A, B and C recently added new approved issues for review. The RAC for Region A, DCS Healthcare, added two issues, DRG validation claims and outpatient claims, to its list for providers in Region A states. CGI, the RAC for Region B, added two new issues…
On October 4, 2010 the Centers for Medicare and Medicaid Services (CMS) published a letter that was sent to state Medicaid directors as part of a series of letters that will provide guidance for the implementation of provisions of the Patient Protection and Affordable Care Act (PPACA), including the expansion…
In September the American Hospital Association (AHA) released its RACTrac for the second quarter of 2010. RACTrac is a nationwide survey conducted by the AHA which documents the ongoing Recovery Audit Contractor (RAC) activity. The purpose of the survey is to fill the void of information provided by the Centers…
On September 10, 2010, CMS released draft form CMS-10343, which will be used by state Medicaid plans to show that they have contracted with a RAC auditor. The forms are used in connection with preparation for Medicaid RAC expansion and include criteria related to payments to the Medicaid RAC and…
The RACs for Region D and Region C added medical necessity reviews to their lists of approved RAC audit issues. HealthDataInsights (HDI), the RAC for Region D, added ten medical necessity reviews to its list of approved issues, while Connolly Healthcare (Connolly), the RAC for Region C, posted 18 medical…
The American Hospital Association (AHA) reported on August 10 that the Centers for Medicare and Medicaid Services (CMS) have approved “medical necessity review” audits for the Recovery Audit Contractor (RAC) program. According to the AHA, the approved audits include 18 types of inpatient hospital claims and one type of durable…
On July 28 the U.S. District Court of the Southern District of California granted the Department of Health and Human Services’ (HHS) motion for summary judgment in the case, Palomar Medical Center v. Sebelius. The case, filed on May 26, 2010, challenged a magistrate judge’s recommendation that HHS is correct…
The Office of Inspector General of the U.S. Department of Health and Human Services (OIG) released a report of its review of inpatient rehabilitation facilities’ transmission of patient assessment instruments for 2006 and 2007. Inpatient rehabilitation facilities (IRFs) are required to submit patient assessment instruments for each stay to the…
Three Recovery Audit Contractors (RACs) posted new issues. The RAC for Region A, DCS Healthcare, posted 23 new approved issues. One new issue applies to DME supplier claims and applies to providers in all Region A states. Connolly Healthcare, the RAC for Region C, posted 3 new issues for non-medical…