Audits

Federal judge blocks new RAC contracts

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Adding to the ongoing controversy around Medicare's Recovery Audit Contractor program, a judge has ruled that the government cannot award new RAC contracts until disputed payment terms are resolved.

CMS to hold Medicare Advantage conference

The Centers for Medicare & Medicaid Services will hold its Medicare Advantage & Prescription Drug Oversight & Enforcement 2014 Program Audits conference on Tuesday, June 24 .It is designed to "provide insight into how MA and Part D organizations can best prepare for a CMS performance audit." Participants can attend in-person or virtually.

OIG revenues off $1 billion as oversight relaxes

OIG revenues off $1 billion as oversight relaxes

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Revenues from Department of Health and Human Services Office of Inspector General audits and investigations for the the first half of fiscal 2014 are expected to drop almost $1 billion from the same period last year, bolstering previous revelations that dwindling federal funding for the agency could lead to less restrictive oversight in the year to come.

CFOs' 2014 challenge

CFOs' 2014 challenge

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Your goals as a CFO remain constant: Support the mission. Increase revenue. Consolidate across multiple entities. Budget. Implement internal controls. Facilitate audits and compliance reporting. CFOs want to optimize the organization's returns by carefully managing all the finances.

Preparing charge nurses for success!

Preparing charge nurses for success!

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Today more than ever, we hear about the importance of PROACTIVE approaches to prevent as many unfavorable events as possible. One of the key essential proactive approaches that we can implement is to PREPARE our charge nurses for success! There are times, when new nurses start their position that the orientation or teaching period is cut short because they are "doing just fine" and they are "needed" to take a shift by themselves.

Providers prep for NASL annual meeting

Operators, including many providers of ancillary services, are getting ready for the 24th annual meeting of the National Association for the Support of Long-Term Care. The event will take place Oct. 6-8 at the Phoenix Convention Center. Recently confirmed as a featured speaker is David W. Saÿen, administrator for the San Francisco Regional Office of the Centers for Medicare & Medicaid Services. He'll address implications of the Affordable Care Act, including insurance exchanges. Other sessions will tackle CMS' "expanding audit empire," health data exchanges and other top issues.

Make CMS audits less burdensome, providers urge lawmakers

Make CMS audits less burdensome, providers urge lawmakers

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The Centers for Medicare & Medicaid Services could take a variety of steps to make audits less burdensome, healthcare providers stated in white papers submitted to members of the Senate Finance Committee. The committee released a report Thursday, summarizing stakeholders' input and recommendations for improving the audit process.

'Targeted' EHR upcoding audits on the way

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The Centers for Medicare & Medicaid Services will undertake targeted audits focused on upcoding in electronic health records, according to Acting CMS Administrator Marilyn Tavenner.

Upon further review

Upon further review

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Providers recoiling from recent uptick in therapy claim audits should expect even more scrutiny in the future as regulators look to increase surveillance.

Government will increase EHR upcoding audits, Tavenner says

Government will increase EHR upcoding audits, Tavenner says

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The Centers for Medicare & Medicaid Services will undertake targeted audits focused on upcoding in electronic health records, Acting CMS Administrator Marilyn Tavenner said Tuesday.

OIG: Electronic health records vulnerable to mispayments

OIG: Electronic health records vulnerable to mispayments

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EMRs are expected to become the norm for healthcare providers in the future. But in the infancy of their use, they lack oversight and safeguards, a new report says.

Why are more RAC audits happening? There are trillions of reasons

Why are more RAC audits happening? There are trillions of reasons

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Recovery audit contractors are stepping up their efforts to review Medicare billings. This appears to be a classic case of auditors gone wild.

'Overzealous' investigators undermining anti-fraud efforts, report finds

'Overzealous' investigators undermining anti-fraud efforts, report finds

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The government often hires "overzealous" investigators to detect fraudulent Medicare and Medicaid billing practices, a new report alleges. These examiners often target technical errors instead of unscrupulous practices, the Robert Wood Johnson Foundation's brief asserts.

Senators demand more data on Medicare fraud prevention efforts

Senators demand more data on Medicare fraud prevention efforts

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A multimillion dollar Medicare fraud-fighting command center unveiled by the federal government a week ago is already drawing fire from two Republican lawmakers.

ZPICs: Dangerous and ready to take down providers

ZPICs: Dangerous and ready to take down providers

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Healthcare reform: No matter how much you may loathe it, there's no way around how certain ideas, like pay for performance, aren't going away.

SNF rehab claims scrutinized more than ever, expert says

SNF rehab claims scrutinized more than ever, expert says

Nursing home administrators who can't substantiate every minute of rehab therapy delivered in their building leave themselves open to increasingly common audits and surveys, a top MDS 3.0 expert said Tuesday.

House committee puts Medicare audit contractors on the hotseat

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Lawmakers are asking Medicare contractors for more information about how they go about identifying and reporting potentially fraudulent payments to the Centers for Medicare & Medicaid Services.

Letter: Provider group accuses CMS of using Medicare audits for 'stealth policymaking' purposes

Letter: Provider group accuses CMS of using Medicare audits for 'stealth policymaking' purposes

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A provider group is taking the Centers for Medicare & Medicaid Services to task for improperly using Medicare audits as a means of curtailing high-intensity therapy in skilled nursing facilities.

Medicaid claims audits come up short, report suggests

Medicaid claims audits come up short, report suggests

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The federal program tasked with detecting Medicaid fraud costs more to operate than it has recovered in overpayments, a government investigation found.

Hospitals increasingly use 'observation stay' loophole, data shows

Hospitals increasingly use 'observation stay' loophole, data shows

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Physicians and hospitals increasingly are admitting more Medicare beneficiaries for observation stays rather than as hospital inpatients, new research concludes.

OIG: Regulators need to sharpen retrieval of Medicare overpayments made to providers

OIG: Regulators need to sharpen retrieval of Medicare overpayments made to providers

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Medicare recovery audit contractors have not been diligent enough in collecting previously identified overpayments, a government investigation finds.