In its report, “The Medicare RAC Program: Update to the evaluation of the three-year demonstration,” the Centers for Medicare and Medicaid Services (CMS) reveals that providers have been winning more appeals since its last report in January 2009. The report first noted that the number of reported claims for appeal…
The Director of Health Care for the Government Accountability Office (GAO), Kathleen M. King, recently testified before the Subcommittees on Health and Oversight, Committee on Ways and Means, House of Representatives. An important component of her testimony included a recommendation that Recovery Audit Contractors (RACs) should focus their post-payment review…
The RAC for Region D, HealthDataInsights, added two new RAC issues for Part B claims review to its CMS-approved list. The new issues are co-surgery not billed with modifier 62 and global days. The issues apply to providers in all Region D states. For more information on RAC approved issues…
Recovery Audit Contractors (RACs) recently posted new issues approved for review: The RAC for Region A, DCS Healthcare, added three RAC issues for non-medical necessity claims for providers in the District of Columbia, Maine, Delaware, New Jersey, New York, New Hampshire, Pennsylvania, Rhode Island and Vermont. CGI, the RAC for…
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…