Given the significant financial pressures facing our federal government and with the health and economic security of nearly 48 million American seniors on the line, Congress must act now to authorize CMS to review Medicare claims before they are paid and finally put an end to the rampant wasteful spending within the program.
There is a much more efficient solution to reducing Medicare spending than the proposed broad cuts to the program budget: Reduce the billions of dollars in incorrect payments each year.
Angry lawmakers ripped an overwhelmed Medicare appeals process that has wilted under a tenfold increase in audits recently. Federal officials from two key agencies agreed that the Medicare's Recovery Audit Contractor (RAC) program needs to be revised.
We keep hearing about RACs in skilled nursing homes but we haven't seen any in our state, so why should we worry about them?
Aspects of the Medicare Recovery Audit Contractor program came under intense scrutiny during a Senate Finance Committee hearing in June. Lawmakers questioned auditor payment incentives and a sluggish appeals process.
There are plenty of legal concerns that keep nursing home administrators awake at night. Many times, the demons can be kept under the bed or locked in the closet. But not always.
Here's the good news for providers: new analytics are making it possible to understand and bill your care in ways that would have been impossible just a few years ago. Here's the bad news: The government is quite aware of these new options.
RAC audits: Skilled nursing facilities accounted for miniscule portion of 2011 Medicare overpaymentsFebruary 07, 2013
Skilled nursing facilities accounted for only about $200,000 of $797 million in collected Medicare overpayments in 2011 identified by Recovery Audit Contractors, according to an annual audit report released Tuesday.
A major hospital group has called for a federal investigation into mistakes made by recovery audit contractors. "Numerous inaccuracies" often result in improperly denied payments and decisions that go unpenalized, laments a letter sent by an American Hospital Association leader.
Recovery audit contractors are stepping up their efforts to review Medicare billings. This appears to be a classic case of auditors gone wild.
Recovery audit contractors and Zone Program Integrity Contractors are a real part of long-term care providers' days now. To be prepared for them is the wise move. This webcast, originally recorded live on June 5, 2010, discusses how to cope with RACs and ZPICs, as well as other payment and policy issues. The featured presenter is Patricia Boyer, the president of Boyer and Associates and Ask the Expert columnist for McKnight's Long-Term Care News. The event will be archived for a year for free viewing.
Recently, claims for hospital patients discharged to skilled nursing homes have come under increased review, particularly by various recovery audit contractors. If you know some background and better understand the situation, it can only help.
As skilled nursing facilities adjust to the changes to Medicare that arrived early last month, they must be ready for Recovery Audit Contractors. RACs are independent auditors for the government that are preparing to audit every facility that has submitted Medicare claims.