RACs

RACs recovered $2.4 billion in provider overpayments last year: report

The Medicare Recovery Audit Program identified and corrected more than 1.1 million claims for improper payments worth $2.57 billion in fiscal year 2014, according to a new Centers for Medicare & Medicaid Services report.

Court rules that SNF can't skip part of Medicare appeals process

Long-term care providers may not leapfrog standard administrative appeals in Medicare reviews, as one creative Louisiana nursing home was reminded last week.

RAC beats CMS on payment lawsuit appeal

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A federal appeals court last week ruled that the Centers for Medicare & Medicaid Services violated federal contracting regulations when it stretched out payment terms for recovery audit contractors.

Make auditors also pay for their mistakes, doc group insists

Make auditors also pay for their mistakes, doc group insists

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Recovery Audit Contractors making incorrect accusations should also be penalized, the American Medical Association is telling lawmakers and regulators. Physicians, long-term care operators and other providers have long criticized the RAC system, which rewards the government's contracted investigators based on the volume of "improper payments" they point out.

RACs snatch back $1.8M

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Recovery Audit Contractors collected $1.8 million in Medicare overpayments made to skilled nursing facilities in fiscal year 2013, according to a Congressional report released in late September.

RACs collected nearly $2 million from skilled nursing facilities last year, report shows

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Recovery Audit Contractors recovered $1.8 million in Medicare overpayments made to skilled nursing facilities in fiscal year 2013, according to a Congressional report released Monday.

MedPAC chairman: Three-day stay requirement is 'archaic'

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The government should pay for skilled nursing care without a preliminary three-day hospital stay, and the recovery auditor program should be reformed, Medicare Payment Advisory Commission members said at a meeting Friday.

RACs return $100 million to providers, as criticism grows

RACs return $100 million to providers, as criticism grows

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Medicare Recovery Audit Contractors returned a record $100.4 million in identified underpayments to providers between April and June.

Report: Long-term care providers pay the price for CMS' poor auditor oversight

Report: Long-term care providers pay the price for CMS' poor auditor oversight

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Long-term care and other providers could be facing unfair burdens due to ineffective government oversight of Medicare auditors, according to a new report from a federal watchdog agency.

Congress grills top judge on appeals jam backlog

Congress grills top judge on appeals jam backlog

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There is no easy fix to the staggering backlog of Medicare appeals, a government official said during a July 10 Congressional hearing.

RACs returned a record $100 million to providers in the third quarter, CMS announces

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Medicare Recovery Audit Contractors returned $100.4 million in underpayments to healthcare providers in the third quarter of fiscal year 2014, the Centers for Medicare & Medicaid Services has announced.

CMS announces Medicare appeals without administrative law judge hearings

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Long-term care providers will be able to appeal certain Medicare claims decisions without going through an administrative law judge hearing, the Office of Medicare Hearings and Appeals (OMHA) announced Thursday.

Ask the payment expert ... about continuing RAC requests

Ask the payment expert ... about continuing RAC requests

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I thought the Recovery Audit Contractors (RACs) were on hold. Why did we still get a request for records?

RACs were 'most improved' healthcare auditors for getting back money in 2013, government report states

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Medicare Recovery Audit Contractors dramatically stepped up their overpayment recoveries last year, returning nearly $487 million more to the government than they did in 2012, according to a new report from a federal watchdog agency.

RACs recovered $8,000 from skilled nursing facilities, $2.3 billion overall in 2012, report shows

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Medicare recovery audit contractors collected about $8,000 in fiscal year 2012 through a skilled nursing facility claims review pilot, according to a recently released annual report to Congress.

GAO: Clean up claims reviews

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Government investigators claim — and the Centers for Medicare & Medicaid Services concurs — that more consistency is needed with Medicare post-payment claims reviews.

RACs recoil against bills

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Independent Medicare auditors are criticizing two measures that would put stricter controls on Recovery Audit Contractors.

RACs push back against audit improvement bills

RACs push back against audit improvement bills

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An advocacy group for independent Medicare auditors has sharply criticized two bills that would put new controls on Recovery Audit Contractors. The Medicare Audit Improvement Act of 2013 was introduced in the House of Representatives in March. A Senate version of the bill was introduced last month. The bill would rein in auditors and improve transparency, which have been provider concerns.

Senate takes up bill to improve Medicare audits, address RAC concerns

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A new Senate bill addresses provider concerns over the Medicare audit process, including the role of Recovery Audit Contractors. The House is also considering a version of the "Medicare Audit Improvement Act of 2013," which lawmakers originally introduced in October 2012 and reintroduced in March.

RAC transition: Fewer document requests but no slowing of therapy reviews, CMS says

RAC transition: Fewer document requests but no slowing of therapy reviews, CMS says

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Providers will see fewer Additional Document Requests starting in June, as the Centers for Medicare & Medicaid Services transitions to new Recovery Audit Program contracts. CMS has started the contract procurement process by issuing a request for quotes through the General Services Administration, according to a Medicare newsletter released Thursday.

CMS announces lower minimum request limit for recovery audit contractors

CMS announces lower minimum request limit for recovery audit contractors

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Medicare recovery audit contractors (RACs) can request as few as 20 records in a 45-day period from skilled nursing facilities and other providers as of April 15, according to the Centers for Medicare & Medicaid Services. This is a reduction from the current 35-record minimum request.

TODAY'S THE DAY: McKnight's Online Expo kicks off with session on MDS 3.0 as lawmakers reintroduce audit bill

TODAY'S THE DAY: McKnight's Online Expo kicks off with session on MDS 3.0 as lawmakers reintroduce audit bill

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Representatives Sam Graves (R-MO) and Adam Schiff (D-CA) recently reintroduced a bill to ease audit burdens on long-term care providers. Initially put forward in Oct. 2012, the Medicare Audit Improvement Act would change the way Medicare recovery audit contractors (RACs) operate.

Power to the people? That could mean trouble

Power to the people? That could mean trouble

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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.

Nursing homes are hospitals' silent cheering section on this one

Nursing homes are hospitals' silent cheering section on this one

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It's interesting how competition can make strange bedfellows. Nursing homes and hospitals, for example, are next-door-neighbors on the caregiving block. We all know who has the bigger house on this block, and it often creates resentment.

OIG: Medicare contractors, antipsychotics in SNFs to get a closer look

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The Medicare contractors keeping close tabs on long-term care facilities will be subject to oversight too, according to a federal working plan released this week.

Medicare auditors becoming more active, denying more claims, survey shows

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Requests for medical records by Medicare's fraud-detecting recovery audit contractors (RACs) jumped sharply from the first- to the second-quarter of fiscal year 2012, a new survey reveals.

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.

Report: Improper Medicare Advantage payments fell $1.2 billion in 2011

Report: Improper Medicare Advantage payments fell $1.2 billion in 2011

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Recovery audit contractors and other quality assurance efforts allowed Medicare Advantage to reduce improper payments by $1.2 billion in 2011, according to a new government report.

More collaboration between Medicare and Medicaid fraud detection programs is needed, report finds

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More communication is needed between Medicare and Medicaid's respective program integrity officials, a new report suggests.

Medicare auditors can request twice as many SNF medical records

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Medicare recovery audit contractors (RACs) can now request twice as many resident medical records than previously allowed, according to the Centers for Medicare & Medicaid Services.